Screening for gestational diabetes: usefulness of clinical risk factors

  • Nahid Shirazian
  • Roya Emdadi
  • Marjan Mahboubi
  • Abbas Motevallian
  • Zhaleh Fazel-Sarjuei
  • Narges Sedighpour
  • Seyade-Fateme Fadaki
  • Narges Shahmoradi
Original Article

Abstract

Objective

There is little consensus regarding selective or universal screening for gestational diabetes. The aim of this study is to determine the influence of risk factors on incidence of GDM in Iranian population by using 75 g OGTT.

Methods

At the first prenatal visit, 924 pregnant women were assessed for age, BMI, obstetric history, family history of diabetes, and diagnosis of polycystic ovary syndrome before pregnancy. All eligible women underwent 2-h 75 g oral glucose tolerance test. Gestational diabetes was diagnosed according to American Diabetes Association criteria.

Results

During study period, 68 [7.4% (95% CI 5.9–9.2)] cases of GDM were found. Age, pre-pregnancy BMI, and family history of DM were the independent clinical predictors of GDM. In women with age <25, BMI ≤ 24.9, and negative family history for diabetes, the risk of GDM was 0.008 (0.001–0.044). This risk increased to 0.250 (0.102–0.495) in women with age ≥30, BMI ≥ 30 and positive family history for diabetes. With selective screening and without screening in low risk group, we will do 13.6% (126 of 924) less screening tests while missing potentially 1.5% (1 of 68) of GDM cases.

Conclusion

Age, BMI, and family history of diabetes were independent risk factors in developing gestational diabetes. Concerning these factors, we do not miss substantial number of GDM cases with selective screening.

Keywords

Diagnosis Diabetes Gestational Risk factors 

Abbreviations

GDM

Gestational diabetes mellitus

OGTT

Oral glucose tolerance test

ADA

American Diabetes Association

GCT

Glucose challenge test

References

  1. 1.
    American Diabetes Association (2007) Diagnosis and classification of diabetes mellitus. Diabetes Care 30(Suppl 1):S42–S47CrossRefGoogle Scholar
  2. 2.
    US Preventive Services Task Force (2008) Screening for gestational diabetes mellitus: US Preventive Services Task Force recommendation statement. Ann Intern Med 148:759–765Google Scholar
  3. 3.
    Larijani B, Hossein-nezhad A, Rizvi SW et al (2003) Cost analysis of different screening strategies for gestational diabetes mellitus. Endocr Pract 9:504–509PubMedGoogle Scholar
  4. 4.
    Keshavarz M, Cheung NW, Babaee GR et al (2005) Gestational diabetes in Iran: incidence, risk factors and pregnancy outcomes. Diabetes Res Clin Pract 69:279–286CrossRefPubMedGoogle Scholar
  5. 5.
    Shirazian N, Mahboubi M, Emdadi R et al (2008) Comparison of different diagnostic criteria for gestational diabetes mellitus based on the 75-g oral glucose tolerance test: a cohort study. Endocr Pract 14:312–317PubMedGoogle Scholar
  6. 6.
    Hadaegh F, Tohidi M, Harati H et al (2005) Prevalence of gestational diabetes mellitus in southern Iran (Bandar Abbas City). Endocr Pract 11:313–318PubMedGoogle Scholar
  7. 7.
    Naylor CD, Sermer M, Chen E et al (1997) Selective screening for gestational diabetes mellitus. Toronto Trihospital Gestational Diabetes Project Investigators. N Engl J Med 337:1591–1596CrossRefPubMedGoogle Scholar
  8. 8.
    Poyhonen-Alho MK, Teramo KA, Kaaja RJ et al (2005) 50gram oral glucose challenge test combined with risk factor-based screening for gestational diabetes. Eur J Obstet Gynecol Reprod Biol 121:34–37CrossRefPubMedGoogle Scholar
  9. 9.
    Moses RG, Moses J, Davis WS (1998) Gestational diabetes: do lean young caucasian women need to be tested? Diabetes Care 21:1803–1806CrossRefPubMedGoogle Scholar
  10. 10.
    Sermer M, Naylor CD, Farine D et al. (1998) The Toronto Tri-Hospital Gestational Diabetes Project A preliminary review. Diabetes Care 21(Suppl 2):B33-42.:B33-B42Google Scholar
  11. 11.
    Zawadski JK, Dunaif A (1992) Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP, Merriam GE (eds) Hershman SM (series ed) Polycystic ovary syndrome, current issues in endocrinology and metabolism. Blackwell Scientific Publications, Boston, p 377Google Scholar
  12. 12.
    Maghbooli Z, Hossein-Nezhad A, Rahmani M et al (2007) Relationship between leptin concentration and insulin resistance. Horm Metab Res 39:903–907CrossRefPubMedGoogle Scholar
  13. 13.
    Azizi F, Azadbakht L, Mirmiran P (2005) Trends in overweight, obesity and central fat accumulation among Tehranian adults between 1998–1999 and 2001–2002: Tehran Lipid and Glucose Study. Ann Nutr Metab 49:3–8CrossRefPubMedGoogle Scholar
  14. 14.
    Barzin M, Sarbakhsh Eskandary P, Hosseinpanah F (2008) Trend of obesity and abdominal obesity in Tehrainian adults population, Unpublished data from Tehran Lipid and Glucose StudyGoogle Scholar
  15. 15.
    HAPO Study Cooperative Research Group (2002) The hyperglycemia and adverse pregnancy outcome (HAPO) study. Int J Gynaecol Obstet 78:69–77CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Nahid Shirazian
    • 1
  • Roya Emdadi
    • 2
  • Marjan Mahboubi
    • 2
  • Abbas Motevallian
    • 3
  • Zhaleh Fazel-Sarjuei
    • 2
  • Narges Sedighpour
    • 2
  • Seyade-Fateme Fadaki
    • 2
  • Narges Shahmoradi
    • 4
  1. 1.Department of Endocrinology and MetabolismIslamic Azad University, Tehran Medical BranchTehranIran
  2. 2.Department of Obstetrics and GynecologyIslamic Azad University, Tehran Medical BranchTehranIran
  3. 3.Department of Epidemiology, School of Public HealthIran University of Medical SciencesTehranIran
  4. 4.Islamic Azad University, Tehran Medical BranchTehranIran

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