title: Selective rather than universal screening for gestational diabetes mellitus?
abstract: OBJECTIVE
  To estimate the proportion of women with gestational diabetes mellitus (GDM) who would be missed by selective versus universal screening and to describe their pregnancy outcomes.
  
  
  METHODS
  An observational cohort study in a single center performing universal screening for GDM with a 75 g oral glucose challenge test (OGTT) at 24-28 weeks gestation. We excluded women with pregestational or first trimester diabetes, those not screened and deliveries <34 weeks. Risk factors were age ≥ 35 years, BMI ≥ 25, family history of diabetes, GDM in a previous pregnancy or macrosomia in a previous pregnancy. Main outcomes were large for gestational age (LGA>90th centile for gestational age, adjusted for gender) and small for gestational age<10th centile.
  
  
  RESULTS
  Among 2187 women screened, 309 (14%) had GDM, of whom 256 (83%) had one or more risk factors. The proportion of women who had GDM despite the absence of any risk factor was 2.4%. In multivariate analysis, LGA was significantly associated with GDM only in case of risk factors. Mean fasting blood glucose was lower in GDM without risk factors than in GDM with risk factors (87 ± 1 mg/dl versus 94 ± 14, p<0.001) and fewer required insulin (6% versus 26%, respectively, p<0.001).
  
  
  CONCLUSIONS
  Selective screening would have missed one-sixth of GDM cases, but these cases seemed milder, with normal fasting blood glucose, and thus less likely to lead to perinatal complications. Whereas an opt-in approach relies heavily on accurate patient screening, we suggest that screening tests could be avoided in low-risk women by an opt-out approach.
authors.affiliation: Hôpital Louis Mourier, Hôpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Department of Obstetrics and Gynecology, Colombes, France; Université Paris-Diderot, Paris, France; "DHU Risks in Pregnancy" University Department, Paris, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Miailhe
authors.affiliation: Hôpital Louis Mourier, Hôpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Department of Obstetrics and Gynecology, Colombes, France; Université Paris-Diderot, Paris, France; "DHU Risks in Pregnancy" University Department, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Kayem
authors.affiliation: Hôpital Louis Mourier, Hôpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Department of Obstetrics and Gynecology, Colombes, France; Université Paris-Diderot, Paris, France; "DHU Risks in Pregnancy" University Department, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Girard
authors.affiliation: Hôpital Louis Mourier, Hôpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Department of Obstetrics and Gynecology, Colombes, France; Université Paris-Diderot, Paris, France; "DHU Risks in Pregnancy" University Department, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Legardeur
authors.affiliation: Hôpital Louis Mourier, Hôpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Department of Obstetrics and Gynecology, Colombes, France; Université Paris-Diderot, Paris, France; "DHU Risks in Pregnancy" University Department, Paris, France. Electronic address: laurent.mandelbrot@lmr.aphp.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mandelbrot
mesh_terms: D000328:Adult; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000517:prevention & control*; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D010297:Paris / Q000453:epidemiology; D057285:Precision Medicine; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
keywords: Gestational diabetes mellitus (GDM); Large for gestational age (LGA); Macrosomia; Screening; Selective; Universal