Poster Australasian Diabetes in Pregnancy Annual Scientific Meeting 2013

Implications for Early Pregnancy Glucose Screening Guidelines (#101)

Katherine Allnutt 1 , Georgia Soldatos 2 , Euan Wallace 1 3 , Carolyn Allan 1 2
  1. Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
  2. Department of Diabetes, Monash Health, Melbourne, Victoria, Australia
  3. Women's and Children's Program, Monash Health, Melbourne, Victoria, Australia

Background

Recent national and international guidelines recommend screening for diabetes in early pregnancy. The Australasian Diabetes in Pregnancy Society (ADIPS) recommends screening women at high risk for gestational diabetes mellitus (GDM). The British National Institute for Health and Clinical Excellence (NICE) recommends screening at 16-18 weeks' gestation in women with previous GDM. Early screening for undiagnosed type II diabetes mellitus (T2DM) is recommended by The American Diabetes Association (ADA) and the International Association of the Diabetes and Pregnancy Study Groups (IADPSG); the latter does not set specific criteria and also considers the role of universal screening.

Aim

To identify the number of women considered at risk for hyperglycaemia in early pregnancy according to selective screening guidelines.

Methods

Data from consecutive singleton pregnancies in women without pre-existing diabetes were extracted from the Monash Health Birthing Outcomes System database. Risk profiles were analysed and ADIPS, ADA, NICE and IADPSG guidelines were applied to calculate the number of women requiring early screening.

Results

492 women (41.5% nulliparous) were included. The number of women eligible for early pregnancy screening according to recommended guidelines was:

Recommendation for Screening

Number of Women Recommended for Screening                  

Percentage of Women Recommended for Screening                  

ADIPS*

According to risk factors**

369

75%

ADA

BMI ≥25kg/m2 plus additional risk factor(s) for T2DM

143

29%

NICE

Previous GDM

20

4%

IADPSG#

Universal

492

100%

   *ADIPS Consensus Guidelines Version 2 - 3.5.13

   ** BMI, age, ethnicity, family history T2DM, previous GDM or glucose abnormality, macrosomia, PCOS, medications (antipsychotics, steroids)

   #IADPSG also recommend risk factor based screening but do not list specific risk factors

42 women were diagnosed with GDM (47.6% nulliparous) according to current ADIPS criteria at 24-28 weeks' gestation. 

Conclusions

It is appropriate that women at high risk of abnormal glucose status in early pregnancy are screened, however current recommendations vary widely and their effectiveness has yet to be evaluated. The potential implications for resource allocation in adopting these guidelines are significant.