title: [Comparing two screening policies of gestational diabetes mellitus: The Mohammed V Training Military Hospital of Rabat (Morocco)].
abstract: OBJECTIVE
  We wanted to measure the impact of going from a two-step screening for gestational diabetes mellitus (50g oral glucose tolerance test then 100g OGTT) to a one-step screening 75g OGTT (WHO's recommendations).
  
  
  METHODS
  A prospective study was carried out among patients who consulted between July 1st, 2008 and October 31st, 2009. The screening was performed in the first trimester if risk factors were identified and between 24 and 28 weeks of gestation (WG).
  
  
  RESULTS
  During our period of study of 15 months, 706 pregnant women were included. The prescription of a screening test was performed in 403 women, i.e. 57% of cases. Out of the 403-screened women, 33 had gestational diabetes mellitus (GDM) i.e. a 8.2% prevalence rate. In univariate analysis, the following are considered to be risk factors: age, diabetes family history and macrosomia history in a previous pregnancy. Between 24 and 28 WG, 34.34% of the screening tests were achieved. The 75g OGTT is prescribed in 96.2% of cases as a screening test of GDM but fasting blood glucose is still prescribed in 3.8% of cases. Also, before 12 WG, 75g OGTT represent 64.7% of the prescribed tests.
  
  
  CONCLUSIONS
  Despite the simplification of the GDM screening procedure, our work shows no significant difference of the screening rate and prevalence of GDM between our present study and the first work done in the same service (57% versus 61%, P=0.7 and 8.2% versus 7.7%, P=0.9). The GDM risk factors found are also identical between the two studies: age, type 2 diabetes family history and macrosomia history. Moreover, there is a statistically significant improvement in the screening age (23±6.7 versus 20.9 WG±6.8 in the first half of 2008, P<0.001) and the number of tests ordered during the period between 24 and 28 WG (34.34% versus 23.9% in the first half of 2008, P<0.001). For the GDM screening tests between 24 and 28 WG, 75g OGTT replaced the 50g OGTT (test used in the first study), but fasting blood glucose is prescribed in 3.8% of cases knowing that normal fasting blood glucose alone done between 24 and 28 WG has a poor sensitivity and do not exclude the diagnosis of GDM (Cosson, 2006) [11]. Also, before 12 WG, 75g OGTT represents 64.7% of the prescribed tests. However, there is to date no data to validate load testing before 24 WG.
  
  
  CONCLUSIONS
  Our comparative study revealed maintenance of low implementation of universal screening of GDM despite the simplification of the protocol. Between 24 and 28 WG, 75g OGTT replaced the 50g OGTT, but fasting blood glucose was still prescribed. A sensitization meeting involving all intervening persons is to be organized with proposals for corrective actions. The final objective is the systematic screening of gestational diabetes mellitus with the use of fasting blood glucose in the first trimester and the 75g OGTT between 24 and 28 weeks of gestation.
authors.affiliation: Service de biochimie, hôpital militaire d'instruction Mohamed V, BP 6341 Rabat Madinat Al Irfane, Rabat, Maroc. Electronic address: bouhsainsanae1@yahoo.fr.
authors.forename: S
authors.initials: S
authors.lastname: Bouhsain
authors.affiliation: Service de biochimie, hôpital militaire d'instruction Mohamed V, BP 6341 Rabat Madinat Al Irfane, Rabat, Maroc.
authors.forename: S
authors.initials: S
authors.lastname: El Kochri
authors.affiliation: Service de gynécologie, hôpital militaire d'instruction Mohamed V, Rabat, Maroc.
authors.forename: M A
authors.initials: MA
authors.lastname: Babahabib
authors.affiliation: Service de gynécologie, hôpital militaire d'instruction Mohamed V, Rabat, Maroc.
authors.forename: M H
authors.initials: MH
authors.lastname: Hafidi
authors.affiliation: Service d'hygiène et de médecine de collectivité, hôpital militaire d'instruction Mohamed V, Rabat, Maroc.
authors.forename: E
authors.initials: E
authors.lastname: Bouaiti
authors.affiliation: Service de gynécologie, hôpital militaire d'instruction Mohamed V, Rabat, Maroc.
authors.forename: M D
authors.initials: MD
authors.lastname: Moussaoui
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D016640:Diabetes, Gestational / Q000175:diagnosis*; D005215:Fasting; D005260:Female; D005865:Gestational Age; D005951:Glucose Tolerance Test; D006772:Hospitals, Military; D006801:Humans; D008403:Mass Screening; D009018:Morocco; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
keywords: Diabète gestationnel; Diagnosis; Diagnostic; Gestational diabetes mellitus