Changing the protocol for gestational diabetes mellitus screening

Ng, Dora, Beckmann, Michael, Mcintyre, Harold David and Wilkinson, Shelley A. (2015) Changing the protocol for gestational diabetes mellitus screening. Australian and New Zealand Journal of Obstetrics and Gynaecology, 55 5: 427-433. doi:10.1111/ajo.12346

Author Ng, Dora
Beckmann, Michael
Mcintyre, Harold David
Wilkinson, Shelley A.
Title Changing the protocol for gestational diabetes mellitus screening
Journal name Australian and New Zealand Journal of Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 1479-828X
Publication date 2015-07-16
Sub-type Article (original research)
DOI 10.1111/ajo.12346
Volume 55
Issue 5
Start page 427
End page 433
Total pages 7
Place of publication Richmond, VIC Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Formatted abstract
Background:  Gestational diabetes mellitus (GDM) affects 5–8% of pregnant women in Australia and is linked to adverse maternal and neonatal outcomes. Earlier diagnosis and treatment has been suggested to improve these outcomes.

Aim:  To describe the experience of a change in GDM screening policy at a large tertiary hospital.

Materials and Methods:  A 6-month audit was performed following a policy change involving introduction of screening for all women early in pregnancy (by either random blood glucose level (BGL) or oral glucose tolerance testing (OGTT), depending on their perceived risk of developing GDM), followed by universal OGTT at 26–28 weeks' gestation. The prevalence of GDM (including changes expected from new Australasian Diabetes in Pregnancy Society (ADIPS) criteria), maternal and neonatal outcomes and adherence to new screening policy are reported.

Results:  The prevalence of GDM was 7.9% (1.6% early, 6.3% later diagnoses). More women with early diagnoses required insulin. Early testing with random BGL for low-risk women only identified 1.7% of those with GDM. Early OGTT for high-risk women identified 24.9% of GDM diagnoses. Adherence to the new screening protocol was generally poor, with 26% adherence at booking, 64% at 26 weeks' gestation and 27% with unknown GDM status.

Conclusions:  While early testing with OGTT for high-risk women may be helpful, the value of early testing with random BGL for low-risk women is questionable. The new ADIPS criteria are likely to increase the number of women diagnosed with GDM (with an emphasis on earlier diagnosis), but the absolute increase remains small.
Keyword Early diagnosis
Gestational diabetes
Glucose tolerance test
Mass screening
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Early view of article. Published online 16 July 2015.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
Official 2016 Collection
School of Medicine Publications
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