Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Endocrinology & Metabolism, gestational diabetes mellitus, preference for screening method, tolerance, glucose challenge test, two-step screening, one-step screening, oral glucose tolerance test, GLUCOSE-TOLERANCE, INSULIN SENSITIVITY, PREGNANCY, CLASSIFICATION, HYPERGLYCEMIA, MANAGEMENT, RESISTANCE, MELLITUS, TRIAL, Adult, Blood Glucose, Cohort Studies, Diabetes, Gestational, Female, Glucose Tolerance Test, Humans, Mass Screening, Patient Preference, Population Surveillance, Pregnancy, Prospective Studies, STG/19/003#55387566, 1800220N#55342169, 1103 Clinical Sciences, 1111 Nutrition and Dietetics, 3202 Clinical sciences

Abstract:

AIMS: To determine the preferred method of screening for gestational diabetes mellitus (GDM). METHODS: 1804 women from a prospective study (NCT02036619) received a glucose challenge test (GCT) and 75g oral glucose tolerance test (OGTT) between 24-28 weeks. Tolerance of screening tests and preference for screening strategy (two-step screening strategy with GCT compared to one-step screening strategy with OGTT) were evaluated by a self-designed questionnaire at the time of the GCT and OGTT. RESULTS: Compared to women who preferred one-step screening [26.2% (472)], women who preferred two-step screening [46.3% (834)] were less often from a minor ethnic background [6.0% (50) vs. 10.7% (50), p=0.003], had less often a previous history of GDM [7.3% (29) vs. 13.8% (32), p=0.008], were less often overweight or obese [respectively 23.1% (50) vs. 24.8% (116), p<0.001 and 7.9% (66) vs. 18.2% (85), p<0.001], were less insulin resistant in early pregnancy (HOMA-IR 8.9 (6.4-12.3) vs. 9.9 (7.2-14.2), p<0.001], and pregnancy outcomes were similar except for fewer labor inductions and emergency cesarean sections [respectively 26.6% (198) vs. 32.5% (137), p=0.031 and 8.2% (68) vs. 13.0% (61), p=0.005]. Women who preferred two-step screening had more often complaints of the OGTT compared to women who preferred one-step screening [50.4% (420) vs. 40.3% (190), p<0.001]. CONCLUSIONS: A two-step GDM screening involving a GCT and subsequent OGTT is the preferred GDM screening strategy. Women with a more adverse metabolic profile preferred one-step screening with OGTT while women preferring two-step screening had a better metabolic profile and more discomfort of the OGTT. The preference for the GDM screening method is in line with the recommended Flemish modified two-step screening method, in which women at higher risk for GDM are recommended a one-step screening strategy with an OGTT, while women without these risk factors, are offered a two-step screening strategy with GCT. CLINICAL TRIAL REGISTRATION: NCT02036619 https://clinicaltrials.gov/ct2/show/NCT02036619.