Selective screening misses gestational diabetes

By Sally Robertson, B.Sc.Oct 4 2012

Selective screening for gestational diabetes does not always identify women who have the condition, shows research.

The findings, presented at the 48^th Annual Meeting of the European Association for the Study of Diabetes in Berlin, Germany suggest that "selective screening is missing low risk women who are having adverse outcomes and thus underestimates the prevalence of adverse outcomes in this group," said lead author Gerard Healy, from University College Hospital in Galway, Ireland.

"In those it does identify it identifies them later," added Healy. Furthermore, "cases of neonatal morbidities, neonatal unit admissions and macrosomia are not being correctly assigned to gestational diabetes."

Recently, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommended universal screening of all pregnancies. However, in the UK and other countries selective screening is still recommended.

Research into the area is hard to interpret, explained Healy. Although a systematic review from 2010 acknowledged that selective screening misses 3-15% of cases, the evidence was not strong enough to recommend US.

Healy and team's multicentre cohort study retrospectively compared the two screening processes in a population of Irish women, and showed that of 5286 who were universally screened, 557 (10.5%) were diagnosed with gestational diabetes. Using selective screening, which included women on the basis of body mass index, age, family history of diabetes, pregnancy history, and ethnicity, 465 of 562 were identified as having the condition.

More women who were selectively screened received their diagnosis after 28 weeks of gestation compared with those who were universally screened, at 45.7% versus 32.9%.

Percentages of adverse events detected were lowest among those with normal glucose tolerance on universal screening, intermediate among those with gestational diabetes picked up in selective screening, and highest among patients identified as having gestational diabetes on universal screening.

Assuming that universal screening is the gold standard and detects the population prevalence for adverse outcomes in gestational diabetes pregnancies, the results show that selective screening potentially misses 2.1% of pre-eclampsia, 7.3% of adverse birth outcomes, and 6.9% of the neonatal admissions associated with the condition, reported Healy.

Women with gestational diabetes who are not identified and their newborns miss the opportunity for timely diagnosis and appropriate evidence-based interventions, which may limit adverse pregnancy outcomes and influence future health of the mother and her offspring, he concluded.

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