title: No consensus on gestational diabetes mellitus screening regimes in Sweden: pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study.
abstract: BACKGROUND
  Although associated adverse pregnancy outcomes, no international or Swedish consensus exists that identifies a cut-off value or what screening method to use for definition of gestational diabetes mellitus. This study investigates the following: i) guidelines for screening of GDM; ii) background and risk factors for GDM and selection to OGTT; and iii) pregnancy outcomes in relation to GDM, screening regimes and levels of OGTT 2 hour glucose values.
  
  
  METHODS
  This cross-sectional and population-based study uses data from the Swedish Maternal Health Care Register (MHCR) (2011 and 2012) combined with guidelines for GDM screening (2011-2012) from each Maternal Health Care Area (MHCA) in Sweden. The sample consisted of 184,183 women: 88,140 in 2011 and 96,043 in 2012. Chi-square and two independent samples t-tests were used. Univariate and multivariate logistic regression analyses were performed.
  
  
  RESULTS
  Four screening regimes of oral glucose tolerance test (OGTT) (75 g of glucose) were used: A) universal screening with a 2-hour cut-off value of 10.0 mmol/L; B) selective screening with a 2-hour cut-off value of 8.9 mmol/L; C) selective screening with a 2-hour cut-off value of 10.0 mmol/L; and D) selective screening with a 2-hour cut-off value of 12.2 mmol/L. The highest prevalence of GDM (2.9%) was found with a 2-hour cut-off value of 8.9 mmol/L when selective screening was applied. Unemployment and low educational level were associated with an increased risk of GDM. The OR was 4.14 (CI 95%: 3.81-4.50) for GDM in obese women compared to women with BMI <30 kg/m2. Women with non-Nordic origin presented a more than doubled risk for GDM compared to women with Nordic origin (OR = 2.24; CI 95%: 2.06-2.43). Increasing OGTT values were associated with increasing risks of adverse pregnancy outcomes.
  
  
  CONCLUSIONS
  There was no consensus regarding screening regimes for GDM from 2011 through 2012 when four different regimes were applied in Sweden. Increasing levels of OGTT 2-hour glucose values were strongly associated with adverse pregnancy outcomes. Based on these findings, we suggest that Sweden adopts the recent recommendations of the International Association of Diabetes and Pregnancy Study Group (IADPSG) concerning the performance of OGTT and the diagnostic criteria for GDM.
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden. maria.lindqvist@obgyn.umu.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Lindqvist
authors.forename: Margareta
authors.initials: M
authors.lastname: Persson
authors.forename: Marie
authors.initials: M
authors.lastname: Lindkvist
authors.forename: Ingrid
authors.initials: I
authors.lastname: Mogren
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data; D032921:Consensus; D003430:Cross-Sectional Studies; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D004522:Educational Status; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D005951:Glucose Tolerance Test / Q000379:methods*; D006801:Humans; D007236:Infant, Small for Gestational Age; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D015995:Prevalence; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000208:ethnology; D013548:Sweden / Q000453:epidemiology; D014478:Unemployment; D055815:Young Adult
chemical_list: D001786:Blood Glucose