Document Detail


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?
MedLine Citation:
PMID:  21489844     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
N Chevalier; P Fénichel; V Giaume; S Loizeau; A Bongain; G Daideri; F Brucker-Davis; S Hiéronimus
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-11
Journal Detail:
Title:  Diabetes & metabolism     Volume:  -     ISSN:  1878-1780     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607599     Medline TA:  Diabetes Metab     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Affiliation:
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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