| 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? | |
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MedLine Citation:
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PMID: 21489844 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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AIM: Currently, there is no international consensus for gestational diabetes mellitus (GDM) diagnosis. This is a report of our experience of GDM screening according to the 1996 French guidelines. METHODS: For 5years, all pregnant women followed at our hospital (n=11,545) were prospectively screened for GDM between weeks 24 and 28 of pregnancy with a two-step strategy: the O'Sullivan test (OS) with a threshold at 130mg/dL, followed by a 100-g OGTT if positive. GDM was diagnosed according to Carpenter and Coustan criteria. RESULTS: Prevalence of GDM was 4.26% [344/1451 of patients with an OS of 130-199mg/dL (12.1%); and 148 patients with an OS greater than 200mg/dL]. The false-positive rate for the OS was 76.8%. Compared with 140mg/dL, a threshold of 130mg/dL caused 401 additional negative OGTTs in 90% of cases. In 80.7% GDM patients, fasting glucose was less than 95mg/dL. The time lag between OS and OGTT was 3weeks (1-84days). Risk factors associated with GDM were maternal age, preconception overweight and obesity, parity, personal history of GDM or macrosomia, and familial history of obesity (P<0.05), but not diabetes. Also, 20% of GDM patients had no risk factors, whereas they were present in 75% of patients without GDM. CONCLUSION: In our population, a two-step screening strategy for GDM was neither relevant nor efficient. It could be simplified with a single-step definitive screening strategy using a 75-g OGTT, as used in the HAPO study, and as recommended by the IADPSG and the recent French Expert Consensus. At present, there are still no evidence-based arguments to help in deciding between selective or universal screening for GDM. |
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Authors:
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N Chevalier; P Fénichel; V Giaume; S Loizeau; A Bongain; G Daideri; F Brucker-Davis; S Hiéronimus |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-4-11 |
Journal Detail:
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Title: Diabetes & metabolism Volume: - ISSN: 1878-1780 ISO Abbreviation: - Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-4-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9607599 Medline TA: Diabetes Metab Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 Elsevier Masson SAS. All rights reserved. |
Affiliation:
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Service d'endocrinologie, diabète et médecine de la reproduction, hôpital de l'Archet, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, BP 3079, 06202 Nice cedex 3, France; UMR Inserm U895/UNS, centre méditerranéen de médecine moléculaire (C3M), bâtiment universitaire Archimed, 151, route de Saint-Antoine-de-Ginestière, BP 2 3194, 06204 Nice cedex 3, France. |
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