title: Diagnostic and prognostic performances over 9 years of a selective screening strategy for gestational diabetes mellitus in a cohort of 18,775 subjects.
abstract: OBJECTIVE
  We aimed to evaluate a selective screening strategy for gestational diabetes mellitus (GDM) based on the presence of risk factors: BMI ≥25 kg/m(2), age ≥35 years, family history of diabetes, personal history of GDM, or birth of a child with macrosomia.
  
  
  METHODS
  Of 20,630 deliveries between 2002 and 2010, we selected 18,775 deliveries in women with no known diabetes and for whom all risk factors were known. GDM was universally screened and defined as fasting plasma glucose level ≥5.3 mmol/L and/or 2-h postload (75 g) glucose level ≥7.8 mmol/L.
  
  
  RESULTS
  The prevalence of at least one risk factor has increased since 2002 (P < 0.001) from 51.7 to 61.5%, with no change in the GDM prevalence (mean 14.4%, intention to screen). At least one risk factor was present in 58.5% of women who represented 65.3% of all those with GDM. The presence of risk factors was significantly associated with GDM (odds ratio 1.4 [95% CI 1.3-1.5], P < 0.001) and with GDM-related events (preeclampsia/large for gestational age/dystocia) (P < 0.001) with the following incidences: no GDM/no risk factor 8.8%, no GDM/risk factor 11.1%, GDM/no risk factor 16.7%, and GDM/risk factor 18.2%.
  
  
  CONCLUSIONS
  The presence of risk factors increased during the last decade. This condition is predictive of GDM and GDM-related events. However, a selective screening would lead to missing one-third of the women with GDM who, even without risk factors, had more events than women without GDM. Therefore, these data stand against the present selective screening currently proposed in the French guidelines.
authors.affiliation: Centre de Recherche en Nutrition Humaine d’Ile-de-France, Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Paris Cité, Paris 13 University, Bondy, France. emmanuel.cosson@jvr.aphp.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cosson
authors.forename: Amélie
authors.initials: A
authors.lastname: Benbara
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pharisien
authors.forename: Minh Tuan
authors.initials: MT
authors.lastname: Nguyen
authors.forename: Aurélie
authors.initials: A
authors.lastname: Revaux
authors.forename: Boris
authors.initials: B
authors.lastname: Lormeau
authors.forename: Dorian
authors.initials: D
authors.lastname: Sandre-Banon
authors.forename: Nabil
authors.initials: N
authors.lastname: Assad
authors.forename: Camille
authors.initials: C
authors.lastname: Pillegand
authors.forename: Paul
authors.initials: P
authors.lastname: Valensi
authors.forename: Lionel
authors.initials: L
authors.lastname: Carbillon
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D011247:Pregnancy; D012307:Risk Factors
chemical_list: D001786:Blood Glucose