title: Gestational diabetes mellitus screening, management and outcomes in the Cook Islands.
abstract: OBJECTIVE
  To describe current practices for screening for gestational diabetes mellitus in the Cook Islands and consider the implications of alternative screening strategies.
  
  
  METHODS
  Eligible women had antenatal care from January 2009 to December 2012. A non-fasting 50 g glucose challenge between 24 and 28 weeks gestation (positive if 1-hour glucose greater than or equal to 7.8 mmol/L) was followed by a 75 g oral glucose tolerance test (gestational diabetes mellitus diagnosed if fasting glucose greater than or equal to 5.2 mmol/L or 2-hour glucose greater than or equal to 8.0 mmol/L; pregnancy impaired glucose tolerance if positive screen and negative diagnostic test).
  
  
  RESULTS
  Uptake of the screening programme rose from 49.0% to 99.6% by the end of the study period. 646 women had a glucose challenge; for 186/646 (28.8%) the challenge was positive; 183 had an oral glucose tolerance test; 89/646 (13.8%) had pregnancy impaired glucose tolerance; 94/646 (13.9%) had gestational diabetes mellitus. Median maternal weight gain was 6 kg (gestational diabetes mellitus) and 10 kg (normal glucose tolerance); caesarean section rates were 25% and 11% respectively; baby birthweights were not significantly different. 59 women with gestational diabetes mellitus had a post-natal glucose tolerance test at their 6-week check and 21 (35.6%) had diabetes confirmed.
  
  
  CONCLUSIONS
  The gestational diabetes mellitus screening programme has a high uptake and current management appears effective in reducing maternal and fetal weight gain. A proposed new screening programme is outlined.
authors.affiliation: Rarotonga Hospital, Te Marae Ora - Ministry of Health, Cook Islands. m.aung@health.gov.ck.
authors.forename: Yin Yin May
authors.initials: YY
authors.lastname: Aung
authors.forename: Martin
authors.initials: M
authors.lastname: Sowter
authors.forename: Timothy
authors.initials: T
authors.lastname: Kenealy
authors.forename: Josephine
authors.initials: J
authors.lastname: Herman
authors.forename: Alec
authors.initials: A
authors.lastname: Ekeroma
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D004038:Diet, Reducing; D005260:Female; D005951:Glucose Tolerance Test; D020073:Gravidity; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008403:Mass Screening / Q000379:methods*; D008687:Metformin / Q000627:therapeutic use; D010298:Parity; D011114:Polynesia / Q000453:epidemiology; D011247:Pregnancy; D011295:Prenatal Care; D040242:Risk Reduction Behavior; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin