title: The diagnostic and prognostic performance of a selective screening strategy for gestational diabetes mellitus according to ethnicity in Europe.
abstract: BACKGROUND
  The performance of standard selective screening strategies for gestational diabetes mellitus (GDM) may vary according to ethnicity.
  
  
  OBJECTIVE
  We aimed to evaluate the diagnostic and prognostic performance of a selective screening tool to determine whether it accurately predicts GDM and events in women of different ethnicities. The tool selectively screens based on patients having one or more of the following risk factors (RFs): body mass index ≥25 kg/m(2), age ≥35 years, family history of diabetes, and personal history of GDM or macrosomia.
  
  
  METHODS
  We conducted an observational prospective study at a university hospital.
  
  
  METHODS
  We included 17 344 women of European (30.9%), North African (29.6%), Sub-Saharan African (22.2%), Caribbean (8.7%), Indian-Pakistani-Sri Lankan (5.5%), and Asian (3.3%) ethnicities who were without pregravid diabetes and had singleton deliveries (2002-2010).
  
  
  METHODS
  We universally screened GDM and GDM-related events (pre-eclampsia, birth weight ≥4000 g, or dystocia).
  
  
  RESULTS
  Independent of confounding factors, North African (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.21-1.52; P < .001) and Indian-Pakistani-Sri Lankan (OR, 2.52; 95% CI, 2.13-3.00; P < .001) women had more GDM than Europeans, whereas Sub-Saharan African women had less (OR, 0.82; 95% CI, 0.71-0.94; P < .01). Having one or more RFs was associated with GDM among Europeans (OR, 1.45; 95% CI, 1.22-1.76), North African (OR, 1.33; 95% CI, 1.13-1.55), Sub-Saharan African (OR, 1.48; 95% CI, 1.20-1.83), and Caribbean (OR, 1.55; 95% CI, 1.12-2.14) women. Having one or more RFs was also associated with GDM-related events only in European (P < .01) and North African (P < .05) women, with the following incidences in Europeans: no GDM/no RF, 6.9%; no GDM/RF, 9.0%; GDM/no RF, 14.7%; and GDM/RF, 12.6%.
  
  
  CONCLUSIONS
  Standard selective screening criteria were not predictive of GDM in women from India-Pakistan-Sri Lanka and Asia and were associated with GDM-related events only in European and North African women. However, the women with GDM, who were routinely treated, had a poor prognosis, even for those free of RFs. These results support universal screening, irrespective of ethnicity.
authors.affiliation: Paris 13 University, Sorbonne Paris Cité (E.C., C.C.-P., Y.J., I.B., M.T.N., P.V.), Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Intégré Obésité Nord Francilien, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Centre de Recherche en Nutrition Humaine Ile de France, 93143 Bondy, France; Paris 13 University, Sorbonne Paris Cité (E.C., M.T.N.), Unité Mixte de Recherche U557 INSERM/U11125 Institut National de la Recherche Agronomique/Caisse Nationale d'Assurance Maladie/Université Paris 13, Unité de Recherche Epidémiologique Nutritionnelle, 93430 Bobigny, France; and Paris 13 University, Sorbonne Paris Cité (A.B., I.P., L.C.), AP-HP, Jean Verdier Hospital, Department of Obstetrics and Gynecology, 93143 Bondy, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cosson
authors.forename: Camille
authors.initials: C
authors.lastname: Cussac-Pillegand
authors.forename: Amélie
authors.initials: A
authors.lastname: Benbara
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pharisien
authors.forename: Yahya
authors.initials: Y
authors.lastname: Jaber
authors.forename: Isabela
authors.initials: I
authors.lastname: Banu
authors.forename: Minh Tuan
authors.initials: MT
authors.lastname: Nguyen
authors.forename: Paul
authors.initials: P
authors.lastname: Valensi
authors.forename: Lionel
authors.initials: L
authors.lastname: Carbillon
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000208:ethnology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data*; D011379:Prognosis; D055815:Young Adult