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Koivunen S, Kajantie E, Torkki A, Bloigu A, Gissler M, Pouta A, Vääräsmäki M. The changing face of gestational diabetes: the effect of the shift from risk factor-based to comprehensive screening. Eur J Endocrinol 2015; 173:623-32. [PMID: 26282598 DOI: 10.1530/eje-15-0294] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/17/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the effect of the change in the gestational diabetes (GDM) screening policy from risk-factor based to comprehensive screening on the prevalence and type of GDM and characteristics of GDM pregnancies. DESIGN Population-based register study in Finland. Subjects were GDM women who gave birth before (2006, n=5185) and after (2010, n=6683) the policy change. All the other women in those years without pre-pregnancy diabetes acted as controls (51 759 and 52 398 respectively). METHODS GDM women with singleton pregnancy were identified through The Finnish Medical Birth Register by abnormal oral glucose tolerance test or initiation of insulin. Main outcome measures were prevalence of GDM (total and insulin/diet-treated), and caesarean section rate. RESULTS The proportion of screened mothers increased from 27.5 to 51.3% and the total prevalence of GDM from 9.1 to 11.3%. This increase consisted mainly of diet-treated mothers, while the number and proportion of insulin-treated mothers decreased (21.8% vs13.3%, P<0.001). The proportion of primiparous women increased (34.5-39.4%, P<0.0001) and mean pre-pregnancy BMI decreased (28.6-28.2, P<0.001). The overall caesarean section rate remained the same but increased among women with GDM (20.8-22.1%) adjusted odds ratios being 1.22 (95% CI 1.14, 1.31) during comprehensive and 1.10 (95% CI 1.02, 1.19) during risk factor-based screening. CONCLUSIONS The shift to comprehensive screening led to a significant increase in women with GDM, who were more often primiparous and had a lower BMI. Comprehensive screening did not perform better in diagnosing women needing insulin treatment.
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Affiliation(s)
- Sanna Koivunen
- Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden
| | - Eero Kajantie
- Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden
| | - Annukka Torkki
- Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden
| | - Aini Bloigu
- Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden
| | - Mika Gissler
- Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden
| | - Anneli Pouta
- Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden
| | - Marja Vääräsmäki
- Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden
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Neelakandan R, Sethu PS. Early universal screening for gestational diabetes mellitus. J Clin Diagn Res 2014; 8:OC12-4. [PMID: 24959483 DOI: 10.7860/jcdr/2014/8199.4264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/05/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To study the prevalence of Gestational diabetes mellitus and to assess the impact of early universal screening to detect Gestational diabetes mellitus. MATERIALS AND METHODS Consecutive 1106 pregnant women were screened for Gestational diabetes mellitus at their first prenatal visit during the study period of February 2012 to January 2013. All the women were screened with a initial 50 gram one hour glucose challenge test (GCT) and those women who tested positive were subjected to a standardized 75 gram oral glucose tolerance test(OGTT). The prevalence of Gestational diabetes mellitus and its association with age, infertility, obesity, hypertension, family history of diabetes was studied. The impact of early universal screening for GDM was assessed. American diabetic association (ADA) and International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria for diagnosis of Gestational diabetes mellitus was used in our study. RESULTS Of the total 1106 pregnant women who were screened with the initial 50 gram one hour glucose challenge test (GCT), 458 (41.4%) had their one hour plasma glucose value >130 gm/dl. Of the 440 women who responded to and underwent the subsequent 75gram OGTT, 158 (61.2%) had one abnormal value, 73(28.2%) had two abnormal values and 27 (10.5%) had three abnormal values. 64(24.8%) of them had fasting plasma glucose ≥ 92/dl. 36(13.9%) women were found to have GDM in the first trimester (12 weeks), 43 (16.7%) in the 13-18 weeks, 114 (44.1%) in the 19-28 weeks and 65 (25.2%) in the third trimester(28 weeks). The overall prevalence of GDM was 23.3%. There was increased association of GDM with increasing age, parity, family predisposition and infertility. CONCLUSION It is evident that there is increased prevalence of GDM in Indian population. Universal screening for GDM is better to routine risk factor based screening and it should be done at the first prenatal visit for early diagnosis of glucose intolerance in pregnancy especially in countries like India. There is increased association of GDM with infertility, advanced age, obesity, family predisposition and parity.
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Affiliation(s)
- Ramya Neelakandan
- Assistant Professor, Department of Medicine, Chennai Medical College Hospital & Research Centre , Tiruchirapalli, Tamilnadu, India
| | - Prabhu Shankar Sethu
- Professor, Department of Medicine, Chennai Medical College Hospital & Research Centre , Tiruchirapalli, Tamilnadu, India
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