title: 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?
abstract: OBJECTIVE
  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 5 years, 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 130 mg/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 130-199 mg/dL (12.1%); and 148 patients with an OS greater than 200 mg/dL]. The false-positive rate for the OS was 76.8%. Compared with 140 mg/dL, a threshold of 130 mg/dL caused 401 additional negative OGTTs in 90% of cases. In 80.7% GDM patients, fasting glucose was less than 95 mg/dL. The time lag between OS and OGTT was 3 weeks (1-84 days). 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.
  
  
  CONCLUSIONS
  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.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. chevalie@unice.fr
authors.forename: N
authors.initials: N
authors.lastname: Chevalier
authors.forename: P
authors.initials: P
authors.lastname: Fénichel
authors.forename: V
authors.initials: V
authors.lastname: Giaume
authors.forename: S
authors.initials: S
authors.lastname: Loizeau
authors.forename: A
authors.initials: A
authors.lastname: Bongain
authors.forename: G
authors.initials: G
authors.lastname: Daideri
authors.forename: F
authors.initials: F
authors.lastname: Brucker-Davis
authors.forename: S
authors.initials: S
authors.lastname: Hiéronimus
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D018149:Glucose Intolerance / Q000175:diagnosis / Q000453:epidemiology; D005951:Glucose Tolerance Test / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data*; D019083:Mediterranean Region / Q000453:epidemiology; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity