Universal vs. risk-factor-based screening for gestational diabetes—an analysis from a 5-Year Portuguese Cohort
The criteria to screen for Gestational Diabetes Mellitus are not internationally consensual. In opposition to the universal screening performed in Portugal, certain countries advocate a risk-factor-based screening. We aim to compare obstetric and neonatal outcomes in pregnant women with and without risk factors treated for Gestational Diabetes Mellitus.
Retrospective and multicentric study of 12,006 pregnant women diagnosed with Gestational Diabetes Mellitus between 2011 and 2015, in Portugal. Gestational Diabetes Mellitus was diagnosed according to the International Association of the Diabetes and Pregnancy Study Groups criteria. Risk factors: body mass index > 30kg/m2, history of Gestational Diabetes Mellitus, history of macrossomic newborn (birth weight > 4000 g) or first-degree relatives with Type 2 Diabetes Mellitus. Exclusion criteria: lack of data concerning risk factors (n = 1563).
At least one risk factor was found in 68.2% (n = 7123) pregnant women. Pregnant women with risk factors were more frequently medicated with insulin (p < 0.001), caesarean section was more commonly performed (p < 0.001), their newborns were more frequently large-for-gestational-age (p < 0.001) and neonatal morbidity was higher (p = 0.040) in comparison to pregnant women without risk factors. The Diabetes Mellitus reclassification test showed an increased frequency of intermediate hyperglycaemia and Diabetes Mellitus in women with risk factors (p < 0.001).
Almost one-third of pregnant women would have remained undiagnosed if risk-based-factor screening were implemented in Portugal. Women without risk factors presented fewer obstetric and neonatal complications. However, more than one third required insulin therapy.
KeywordsDiabetes gestational Risk factors Diagnosis Mass screening
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
- 2.Diabetologia S. P. Factos e números. Observatório Nacional da Diabetes. http://www.spd.pt/images/bolsas/dfn2015.pdf (2016). Accessed 1 Sept 2017
- 4.World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. WHO. http://www.who.int/diabetes/publications/Hyperglycaemia_In_Pregnancy/en/ (2013). Accessed 1 Sept 2017
- 5.Diabetologia SP. Consenso “Diabetes Gestacional” – Atualização 2016. Portuguese Diabetes and Pregnancy Study Group. http://www.spd.pt/images/consenso_dg_atualizacao2016.pdf (2016). Accessed 1 Sept 2017
- 6.National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. https://www.nice.org.uk/guidance/ng3 (2015). Accessed 1 Sept 2017
- 7.J. Tieu, A. J. McPhee, C. A. Crowther, P. Middleton, E. Shepherd, Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health. Cochrane Database Syst Rev. 8, 1–67 (2017).Google Scholar
- 13.Adam S., Rheeder P. Screening for gestational diabetes mellitus in a South African population: prevalence, comparison of diagnostic criteria and the role of risk factors. 107, 523–527 (2017)Google Scholar
- 15.American Diabetes Association. Standards of Medical Care in Diabetes 2017. Diabetes Care. 40, 1–135, (supplement 1), (2016)Google Scholar
- 20.S. Brito, A. Brett, J. Agro, Large for gestational age newborns: concept and reality. Acta Pediatr. Port. 45, 7–15 (2014)Google Scholar