European Journal of Obstetrics & Gynecology and Reproductive Biology 191 (2015) 95–100

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Selective rather than universal screening for gestational diabetes mellitus?§ Gre´goire Miailhe a,b,c, Gilles Kayem a,b,c, Guillaume Girard a,b,c, He´le`ne Legardeur a,b,c, Laurent Mandelbrot a,b,c,* a

Hoˆpital Louis Mourier, Hoˆpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hoˆpitaux de Paris, Department of Obstetrics and Gynecology, Colombes, France b Universite´ Paris-Diderot, Paris, France c ‘‘DHU Risks in Pregnancy’’ University Department, Paris, France

A R T I C L E I N F O

A B S T R A C T

Article history: Received 1 May 2014 Received in revised form 23 April 2015 Accepted 19 May 2015

Objectives: To estimate the proportion of women with gestational diabetes mellitus (GDM) who would be missed by selective versus universal screening and to describe their pregnancy outcomes. Study design: An observational cohort study in a single center performing universal screening for GDM with a 75 g oral glucose challenge test (OGTT) at 24–28 weeks gestation. We excluded women with pregestational or first trimester diabetes, those not screened and deliveries 90th centile for gestational age, adjusted for gender) and small for gestational age < 10th centile. Results: Among 2187 women screened, 309 (14%) had GDM, of whom 256 (83%) had one or more risk factors. The proportion of women who had GDM despite the absence of any risk factor was 2.4%. In multivariate analysis, LGA was significantly associated with GDM only in case of risk factors. Mean fasting blood glucose was lower in GDM without risk factors than in GDM with risk factors (87  1 mg/dl versus 94  14, p < 0.001) and fewer required insulin (6% versus 26%, respectively, p < 0.001). Conclusion: Selective screening would have missed one-sixth of GDM cases, but these cases seemed milder, with normal fasting blood glucose, and thus less likely to lead to perinatal complications. Whereas an opt-in approach relies heavily on accurate patient screening, we suggest that screening tests could be avoided in low-risk women by an opt-out approach. ß 2015 Elsevier Ireland Ltd. All rights reserved.

Keywords: Gestational diabetes mellitus (GDM) Macrosomia Large for gestational age (LGA) Screening Selective Universal

Introduction Gestational diabetes mellitus (GDM) is associated with shortterm and long-term morbidities for the mother and child. Most of the short-term complications are related to excessive fetal weight [1]. The risk of LGA is related to maternal blood sugar levels [2], with a continuous and linear correlation even at moderate levels of hyperglycemia [3]. Controlling blood sugar levels reduces the

§ Preliminary results presented at the 42nd Congress of the Socie´te´ Franc¸aise de Me´decine Pe´rinatale, Montpellier (France), 19 October 2012 (abstract number CO056). * Corresponding author at: Service de Gynecologie-Obste´trique, Hoˆpital Louis Mourier, HUPNVS, Universite´ Paris-Diderot, 178 rue des Renouillers, 92700 Colombes, France. Tel.: +33 1 47 60 63 39; fax: +33 1 47 60 63 38; mobile: +33 6 85 12 76 88. E-mail address: [email protected] (L. Mandelbrot).

http://dx.doi.org/10.1016/j.ejogrb.2015.05.003 0301-2115/ß 2015 Elsevier Ireland Ltd. All rights reserved.

incidence of LGA and poor pregnancy outcomes in women with GDM, even in case of mild hyperglycemia [4–6]. The International Association of Diabetes in Pregnancy Study Groups (IADPSG) [1] issued guidelines for GDM screening, based on a universal midtrimester 1-step 75 g oral glucose tolerance test (OGTT). These guidelines have been widely adopted worldwide. However, there is concern over the proportion of women diagnosed with GDM with these definitions, on the order of 18% [7] and even more in countries with the highest prevalence of obesity [8]. This is a burden on health-care providers [9], even if is cost/beneficial [10]. For these reasons, consensus is still lacking in the United States [11–13]. Another controversy, which has received less attention, is whether selective or universal screening should be offered [14,15]. In France, practice guidelines issued in December 2010 recommended 1-step screening with IADPSG thresholds, but restricted to women with pre-defined risk factors for GDM [16]. The objectives

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of our study were to estimate the proportion of women with GDM who would be missed by such selective versus universal screening and to analyze obstetrical outcomes for these women. Materials and methods We performed a retrospective cohort study in a tertiary academic perinatal center in the Paris area, including all women who delivered singletons after 24 gestational weeks from 1-042011 to 28-02-2012. The institutional policy was the IADPSG universal 2-h screening with a 75 g oral glucose challenge test (OGTT) at 24–28 weeks gestational age [1,17]. Many women received prenatal care outside the institution until the 3d trimester, but primary care providers were encouraged to follow this policy. First trimester screening with fasting blood sugar was optional, in case of risk factors. Women with pre-gestational diabetes or with an abnormal first trimester blood sugar test were excluded. Screening was considered positive at the IADPSG thresholds adopted by the French obstetrical and diabetes societies (4): 92 mg/dl (5.1 mmol/L) fasting blood glucose (FBG), 180 mg/dl (10 mmol/L) at 1 h or 153 mg/dl (8.5 mmol/L) at 2 h. Women screening positive first received group counseling with a nutritionist and a nurse. A low carbohydrate diet was explained and women were furnished a blood glucose monitor and logbook and instructed to test for capillary blood sugar 6 times daily, before and 2 h after each meal. The objectives were FBS < 90 mg/dl and post-prandial glucose (PPG) < 120 mg/dl. Whenever these objectives were not met, women received individual counseling and in case of persistent and/or high hyperglycemia, were started on insulin. Oral hypoglycemic agents were not used at the time. Further follow-up was done weekly. Within this cohort receiving universal screening, we studied: (1) how many women would not have been screened if testing had been selective, (2) how many GDM cases would have been missed, (3) differences between the low-risk and high-risk populations, and (4) obstetrical and neonatal outcomes. Risk factors were those recommended by the IADPSG [1] and French [16] guidelines: maternal age > 35 years, pre-gestational BMI > 25, family history of diabetes, GDM in a previous pregnancy and/or macrosomia (birthweight >4500 g) in a previous child. Ethnic origin is not considered as a risk factor for GDM in these guidelines [16]. We analyzed the following maternal characteristics: age, geographic origin, parity, GDM in a previous pregnancy, macrosomia in a previous child, family history of diabetes, pregestational BMI, weight gain during the pregnancy, previous cesarean section. The elements regarding GDM were the blood glucose values at the screening test, insulin treatment and weight gain during pregnancy. Obstetrical outcomes were hypertension/ preeclampsia, mode of delivery and shoulder dystocia. In accordance with French practice guidelines [16] we did not perform cesarean sections solely because of diabetes, except in case of estimated fetal weight above 4500 g. Neonatal outcome measures were gestational age at birth, birthweight, birthweight z-score, cord blood arterial pH, Apgar score at 5 min. LGA was defined as >90th centile and small for gestational age (SGA) was defined as 90th centile) incidence was higher in GDM with risk factors than in GDM Table 1 Maternal characteristics. Characteristics were compared between GDM groups with and without risk factors and the no-GDM (reference) group.

Nulliparous, n (%) Maternal age > 35 years, n (%) BMI pre-pregnancy > 25, n (%) Geographic origin, n (%) Europe North Africa Sub-Sahara Africa Others Previous cesarean section, n (%) *

GDM without risk factor n = 53

GDM with risk factor(s) n = 256

No GDM n = 1878

34 (64)* 0* 0*

98 (38)§ 86 (34)*,§ 172 (70)*,§

780 (42) 298 (16) 632 (36)

*,§

25 14 6 5 4

(47) (26) (11) (9) (8)

73 126 30 16 38

(29) (49) (12) (6) (16)*

668 720 283 129 191

(36) (38) (15) (7) (11)

Statistically significant difference (p < 0.05) with no GDM group. Statistically significant difference (p < 0.05) with GDM without risk factor group. §

G. Miailhe et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 191 (2015) 95–100

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Table 2 Association of GDM risk factors in women with GDM, n = 309, compared with women without GDM (reference), n = 1878. GDM status History of GDM

§

OR (95% CI)

aOR (95% CI)

No GDM GDM

57 (5) 50 (28)

1 7.24 (4.75; 11.0)*

1 5.58 (3.63; 8.59)*

Family history of diabetes

No GDM GDM

359 (19) 104 (34)

1 2.15 (1.66; 2.80)*

1 2.60 (1.95; 3.47)*

Age > 35 years

No GDM GDM

298 (16) 86 (28)

1 2.03 (1.54; 2.68)*

1 1.60 (1.17; 2.19)*

BMI > 25

No GDM GDM

632 (36) 172 (59)

1 2.61 (2.02; 3.36)*

1 2.11 (1.61; 2.75)*

History of macrosomia§

No GDM GDM

34 (3) 22 (12)

1 4.47 (2.55; 7.84)*

1 4.07 (1.92; 4.70)*

Logistic regression included the five risk factors; odds ratios (OR), crude and adjusted (aOR); 95% confidence intervals (CI). * Significant difference (p < 0.05). § Restricted to multiparous women.

Table 3 Glycemic characteristics in GDM groups with and without risk factors, compared to no GDM. GDM without risk factor Fasting blood glucose, mg/dl (SD) 75 g OGTT blood glucose at 1 h, mg/dl 75 g OGTT blood glucose at 2 h, mg/dl Insulin required, n (%) Maternal weight gain during pregnancy, kg (95% CI) * **

0.94  0.14 1.74  0.32 1.44  0.32 66 (26)* 9.86  8.71

No GDM 0.79  0.07** 1.23  0.28** 1.08  0.25** 0 11.7  7.07

Significant difference (p < 0.05) between GDM without risk factor and GDM with risk factor(s) groups. Significant difference between GDM without risk factor and no GDM groups.

Table 4 Obstetrical and neonatal outcomes. GDM without risk factor N = 53 Gestational age at delivery, weeks  SD Mode of delivery Cesarean section, n (%) Instrumental vaginal delivery, n (%) Birthweight, grams  SD Birthweight  90th centile Birthweight  10th centile Apgar score at 5 min < 7 Shoulder dystocia, n (%) Hypertension or preeclampsia, n (%)

GDM with risk factor(s) N = 256

39.0  1.9

38.8  2.3

11 (21) 13 (25)

72 (28)* 44 (17)

3137  546 3 (6) 7 (13) 1 (2) 1 (2) 2 (4)

3312  584 43 (17)*,§ 16 (6)* 3 (1) 1 (0.4) 9 (4)

No GDM N = 1878 39.3  2.0

373 (20) 390 (21) 3278  571 156 (8) 211 (11) 29 (2) 10 (0.5) 49 (3)

Statistically significant difference (p < 0.05) with no GDM group. Statistically significant difference (p < 0.05) with GDM without risk factor group. §

*

0.87  0.11 1.63  0.33 1.42  0.33 3 (6) 9.94  11.7

without risk factors and no-GDM (17% versus 6% versus 8%, p < 0.001). There were more SGA ( 25 No hypertension during pregnancy Hypertension/preeclampsia during pregnancy

156 (8) 3 (6) 43 (17)

1 0.66 (0.20–2.15) 2.22 (1.55–3.21)*

1 1.21 (0.36–4.04) 2.04 (1.37–3.02)*

161 38 53 149

(9) (10) (6) (12)

1 1.10 (0.76–1.59) 1 2.14 (1.55–2.97)*

1 0.78 (0.52–1.17) 1 2.09 (1.47–2.97)*

66 95 23 8 93 99 198 4

(9) (11) (7) (5) (7) (12) (9) (7)

1 1.32 0.82 0.60 1 1.75 1 0.70

1 1.13 0.73 0.61 1 1.48 1 0.75

(0.95–1.83) (0.50–1.35) (0.28–1.27) (1.30–2.35)* (0.25–1.94)

(0.80–1.61) (0.44–1.23) (0.28–1.32) (1.07–2.04)* (0.26–2.12)

All of the variables were included in the logistic regression. * Significant association (p < 0.05).

would be required to detect one additional case of GDM. This seems to be reasonable for a screening test, although we did not perform a cost/benefit analysis. The second, most important argument against selective testing is that it relies heavily on patient selection. Among women with risk factors who should have been offered screening, the proportion that was not tested was the same as for low-risk women. This suggests that physicians and midwives may fail to identify women at risk of diabetes. A number of authors have drawn the conclusion that a selective approach avoids a small number of tests and substantially complicates the screening procedure [24]. The number-to-test varies between populations. For instance, in a study from Great Britain [25], the selective approach avoided testing in only 15% of women compared to universal screening and detected only 50% of cases of GDM. In a recent Italian study, where the prevalence of GDM was 11.1% with a universal screening policy, Pintaudi et al. [26] found that the proportion with risk factors in their population was 58.3% and that 23% of cases of GDM would have been missed if selective screening criteria had been applied. These proportions are quite similar to those in our population.

Cosson et al. [19], who studied a population in the Paris outskirts similar to ours, found that universal screening reduced the delay between the diagnosis and access to specific care for GDM. Timely access to care is important for effective care. This may account for the observation that in our institution the incidence of LGA in women with GDM decreased in the 2011–2012 study period, in comparison with the period 2005–2008, as we previously reported [21], i.e. 14% versus 20% with a birthweight z score  1.28. The only difference in management between the two periods was the type of universal screening, which in the earlier period was a 2-step procedure leading to later care for women with GDM. An important drawback to selective screening is the lack of international consensus concerning risk factors as well as thresholds for these factors. In a meta-analysis by Torloni et al. [27], the influence of BMI was linear, with an increase in the incidence of GDM of 0.92% for every 1 kg/m2 increase in BMI. We also found a linear correlation between BMI and LGA. Others suggested that in using selective screening, the cut-offs for BMI and maternal age should be lower than those adopted by the French guidelines [28], more specifically with a cut-off for maternal age  25 years

Table 6 Risk of SGA 1.88) in our GDM group without risk factors. There are however limits to our analysis. First, maternal age and BMI are risk factors which are common to GDM and LGA and were therefore included in the multivariate analysis, with a potential risk of over-adjustment. Most importantly, since our patients diagnosed with GDM were treated as required, we cannot determine what the risk of LGA related to GDM in low-risk women would be without GDM screening. Nonetheless, our results are consistent with previous findings indicating that mild GDM is not associated with adverse perinatal outcomes [41]. The HAPO study [3] showed that fetal hyperinsulinemia begins to increase even at moderate levels of hyperglycemia, but there was an important interaction with obesity [42]. In patients with untreated GDM, Langer et al. [5] observed that the risks of LGA and shoulder dystocia were highly dependent on the maternal BMI. Furthermore, there may be disadvantages to treating GDM in low-risk women due to universal screening [43]. Aggressive management of these low-risk women, while reducing the risk of LGA, might lead to fetal growth restriction. In a study by Chevalier

99

et al. [44] on 2014 women who underwent systematic screening, treatment of GDM was associated with a SGA rate of 20%, versus 13.3% in patients with risk factors. In our study, the incidence of SGA tended to be higher in GDM without risk factors than in GDM with risk factors, but this did not reach statistical significance. Because this was an observational study, there was no way to control for treatment differences. Some observational studies did report poorer outcomes in women with GDM but no risk factors, compared to women without GDM [19,31]. The practice guidelines we followed did not recommend different management in women with a diagnosis of GDM according to whether or not they had risk factors. However, there may have been differences in management according to plasma glucose levels and excessive fetal growth and/ or amniotic fluid. It should be noted our GDM patients without risk factors gained more weight than those with risk factors, suggesting that diet prescriptions were possibly less aggressive than for women with risk factors, thereby limiting any potential negative impact of treating low-risk GDM. Another concern about diagnosing GDM in low-risk women is a potential increase in cesarean sections [45–47]. We found that GDM was associated with a higher rate of C-section in case of risk factors only [4,46]. In conclusion, universal screening has the major practical advantage of being simple, while improving sensitivity for detecting GDM. In contrast, selective screening identifies the cases of GDM which are at highest risk of complications, whereas those which would be missed appear to be milder, characterized by normal fasting blood glucose and are thus less likely to lead to perinatal complications. Whether there is or not a benefit to screening these women cannot be determined at present, since this would require a randomized study with a group receiving no treatment, as was performed for mild hyperglycemia in populations with a high prevalence of risk factors [4,48]. Regarding the long-term consequences for the woman and for the child, there is at present no data to indicate the benefits of diagnosing GDM in women without risk factors, and the question remains to be addressed. In order to implement selective screening without missing women with risk factors, an ‘‘opt-out’’ approach whereby women without risk factors are exempted from testing would be less demanding on the health provider than an ‘‘opt-in’’ approach. The choice between universal and selective screening should depend on the organization of prenatal care and the characteristics of the pregnant population [44], which differ widely between centers around the world.

Conflict of interest The authors report no conflict of interest.

Financial support No financial support. References [1] Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007;30(Suppl 2):S251–60. [2] Lepercq J, Timsit J, Hauguel-de Mouzon S. Etiopathogeny of fetal macrosomia. J Gynecol Obstet Biol Reprod (Paris) 2000;29:6–12. [3] HAPO SCRG, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002. [4] Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477–86. [5] Langer O, Mazze R. The relationship between large-for-gestational-age infants and glycemic control in women with gestational diabetes. Am J Obstet Gynecol 1988;159:1478–83.

100

G. Miailhe et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 191 (2015) 95–100

[6] Coustan D. Treating mild gestational diabetes yields benefits with little or no evidence of harms. Evid Based Med 2014;19(3):88. http://dx.doi.org/10.1136/ eb-2013-101520. [7] Moses RG. New consensus criteria for GDM: problem solved or a Pandora’s box? Diabetes Care 2010;33:690–1. [8] Sacks DA, Hadden DR, Maresh M, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care 2012;35:526–8. [9] Reece EA, Moore T. The diagnostic criteria for gestational diabetes: to change or not to change? Am J Obstet Gynecol 2013;208:255–9. [10] Mission JF, Ohno MS, Cheng YW, Caughey AB. Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis. Am J Obstet Gynecol 2012;207:326 e1–e3269. [11] American-Diabetes-Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2012;35(Suppl 1):S64–71. [12] ACOG CoP. Practice Bulletin No. 137: gestational diabetes mellitus. Obstet Gynecol 2013;122:406–16. [13] Moyer VA, U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014;160(6):414–20. http://dx.doi.org/10.7326/M132905. [14] Cosson E, Benchimol M, Carbillon L, et al. Universal rather than selective screening for gestational diabetes mellitus may improve fetal outcomes. Diabetes Metab 2006;32:140–6. [15] Hieronimus S, Le Meaux JP. Relevance of gestational diabetes mellitus screening and comparison of selective with universal strategies. Diabetes Metab 2010;36:575–86. [16] CNGOF. Gestational diabetes. J Gynecol Obstet Biol Reprod 2010;39:S139. S338–42. [17] Coustan DR, Lowe LP, Metzger BE, Dyer AR. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus. Am J Obstet Gynecol 2010;202:654. e1–6. [18] Salomon LJ, Bernard JP, de Stavola B, Kenward M, Ville Y. Birth weight and size: charts and equations. J Gynecol Obstet Biol Reprod (Paris) 2007;36:50–6. [19] Cosson E, Benbara A, Pharisien I, et al. Diagnostic and prognostic performances over 9 years of a selective screening strategy for gestational diabetes mellitus in a cohort of 18,775 subjects. Diabetes Care 2013;36:598–603. [20] Vendittelli F, Riviere O, Crenn-Hebert C, et al. Audipog perinatal network. Part 1: Principal perinatal health indicators, 2004–2005. Gynecol Obstet Fertil 2008;36:1091–100. [21] Legardeur H, Girard G, Journy N, Ressencourt V, Durand-Zaleski I, Mandelbrot L. Factors predictive of macrosomia in pregnancies with a positive oral glucose challenge test: importance of fasting plasma glucose. Diabetes Metab 2014;40(1):43–8. http://dx.doi.org/10.1016/j.diabet.2013.01.008. [22] Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol 2003;101:380–92. [23] Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care 1998;21(Suppl 2):B161–7. [24] Corcoy R, Garcia-Patterson A, Pau E, et al. Is selective screening for gestational diabetes mellitus worthwhile everywhere. Acta Diabetol 2004;41:154–7. [25] Minsart AF, Lescrainier JP, Vokaer A. Selective versus universal screening for gestational diabetes mellitus: an evaluation of Naylor’s model. Gynecol Obstet Invest 2009;68:154–9. [26] Pintaudi B, Di Vieste G, Corrado F, et al. Improvement of selective screening strategy for gestational diabetes through a more accurate definition of highrisk groups. Eur J Endocrinol 2014;170:87–93. [27] Torloni MR, Betran AP, Horta BL, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 2009;10:194–203. [28] Yang X, Hsu-Hage B, Yu L, Simmons D. Selective screening for gestational diabetes in Chinese women. Diabetes Care 2002;25:796.

[29] Caliskan E, Kayikcioglu F, Ozturk N, Koc S, Haberal A. A population-based risk factor scoring will decrease unnecessary testing for the diagnosis of gestational diabetes mellitus. Acta Obstet Gynecol Scand 2004;83:524–30. [30] van Leeuwen M, Opmeer BC, Zweers EJ, et al. Estimating the risk of gestational diabetes mellitus: a clinical prediction model based on patient characteristics and medical history. BJOG 2010;117:69–75. [31] Avalos GE, Owens LA, Dunne F. Applying current screening tools for gestational diabetes mellitus to a European population: is it time for change. Diabetes Care 2013;36:3040–4. [32] Cosson E, Cussac-Pillegand C, Benbara A, et al. The diagnostic and prognostic performance of a selective screening strategy for gestational diabetes mellitus according to ethnicity in Europe. J Clin Endocrinol Metab 2014;99:996–1005. [33] College national des gynecologues et obstetriciens f, Societe francophone du d. Gestational diabetes. J Gynecol Obstet Biol Reprod 2010;39:S139. S338–42. [34] Sermer M, Naylor CD, Farine D, et al. The Toronto Tri-Hospital Gestational Diabetes Project. A preliminary review. Diabetes Care 1998;21(Suppl 2):B33–42. [35] Durnwald CP, Mele L, Spong CY, et al. Glycemic characteristics and neonatal outcomes of women treated for mild gestational diabetes. Obstet Gynecol 2011;117:819–27. [36] Riskin-Mashiah S, Damti A, Younes G, Auslender R. First trimester fasting hyperglycemia as a predictor for the development of gestational diabetes mellitus. Eur J Obstet Gynecol Reprod Biol 2010;152:163–7. [37] Mahdavian M, Hivert MF, Baillargeon JP, Menard J, Ouellet A, Ardilouze JL. Gestational diabetes mellitus: simplifying the international association of diabetes and pregnancy diagnostic algorithm using fasting plasma glucose: comment on agarwal, dhatt, and shah. Diabetes Care 2010;33:e145. author reply e6. [38] Black MH, Sacks DA, Xiang AH, Lawrence JM. Clinical outcomes of pregnancies complicated by mild gestational diabetes mellitus differ by combinations of abnormal oral glucose tolerance test values. Diabetes Care 2010;33:2524–30. [39] Voldner N, Qvigstad E, Froslie KF, Godang K, Henriksen T, Bollerslev J. Increased risk of macrosomia among overweight women with high gestational rise in fasting glucose. J Matern Fetal Neonatal Med 2010;23:74–81. [40] Coustan DR. Pregnancy outcomes in women with and without gestational diabetes mellitus according to the international association of the diabetes and pregnancy study groups criteria. Obstet Gynecol 2013;121:377. [41] Figueroa D, Landon MB, Mele L, et al. Relationship between 1-hour glucose challenge test results and perinatal outcomes. Obstet Gynecol 2013;121: 1241–7. [42] Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care 2012;35:780–6. [43] Wen SW, Liu S, Kramer MS, et al. Impact of prenatal glucose screening on the diagnosis of gestational diabetes and on pregnancy outcomes. Am J Epidemiol 2000;152:1009–14. discussion 15–6. [44] Chevalier N, Fenichel P, Giaume V, et al. Universal two-step screening strategy for gestational diabetes has weak relevance in French Mediterranean women: should we simplify the screening strategy for gestational diabetes in France? Diabetes Metab 2011;37:419–25. [45] Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med 2013;159:123–9. [46] Miailhe G, Le Ray C, Timsit J, Lepercq J. Factors associated with urgent cesarean delivery in women with type 1 diabetes mellitus. Obstet Gynecol 2013;121: 983–9. [47] Horvath K, Koch K, Jeitler K, et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 2010;340:c1395. [48] Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339–48.

Selective rather than universal screening for gestational diabetes mellitus?

To estimate the proportion of women with gestational diabetes mellitus (GDM) who would be missed by selective versus universal screening and to descri...
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