title: Changing the protocol for gestational diabetes mellitus screening.
abstract: BACKGROUND
  Gestational diabetes mellitus (GDM) affects 5-8% of pregnant women in Australia and is linked to adverse maternal and neonatal outcomes. Earlier diagnosis and treatment has been suggested to improve these outcomes.
  
  
  OBJECTIVE
  To describe the experience of a change in GDM screening policy at a large tertiary hospital.
  
  
  METHODS
  A 6-month audit was performed following a policy change involving introduction of screening for all women early in pregnancy (by either random blood glucose level (BGL) or oral glucose tolerance testing (OGTT), depending on their perceived risk of developing GDM), followed by universal OGTT at 26-28 weeks' gestation. The prevalence of GDM (including changes expected from new Australasian Diabetes in Pregnancy Society (ADIPS) criteria), maternal and neonatal outcomes and adherence to new screening policy are reported.
  
  
  RESULTS
  The prevalence of GDM was 7.9% (1.6% early, 6.3% later diagnoses). More women with early diagnoses required insulin. Early testing with random BGL for low-risk women only identified 1.7% of those with GDM. Early OGTT for high-risk women identified 24.9% of GDM diagnoses. Adherence to the new screening protocol was generally poor, with 26% adherence at booking, 64% at 26 weeks' gestation and 27% with unknown GDM status.
  
  
  CONCLUSIONS
  While early testing with OGTT for high-risk women may be helpful, the value of early testing with random BGL for low-risk women is questionable. The new ADIPS criteria are likely to increase the number of women diagnosed with GDM (with an emphasis on earlier diagnosis), but the absolute increase remains small.
authors.affiliation: Department of Obstetrics & Gynaecology, Mater Mothers Hospital, Raymond Tce, South Brisbane, Queensland, Australia.
authors.forename: Dora
authors.identifier: http://orcid.org/0000-0003-4531-4698
authors.initials: D
authors.lastname: Ng
authors.affiliation: Department of Obstetrics & Gynaecology, Mater Mothers Hospital, Raymond Tce, South Brisbane, Queensland, Australia.|Mater Research Institute, University of Queensland, Raymond Tce, South Brisbane, Queensland, Australia.|University of Queensland School of Medicine, Raymond Tce, South Brisbane, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Beckmann
authors.affiliation: Mater Research Institute, University of Queensland, Raymond Tce, South Brisbane, Queensland, Australia.|University of Queensland School of Medicine, Raymond Tce, South Brisbane, Queensland, Australia.|Mater Hospital, Raymond Tce, South Brisbane, Queensland, Australia.
authors.forename: Harold David
authors.initials: HD
authors.lastname: Mcintyre
authors.affiliation: Mater Research Institute, University of Queensland, Raymond Tce, South Brisbane, Queensland, Australia.|Mater Hospital, Raymond Tce, South Brisbane, Queensland, Australia.|Department of Nutrition & Dietetics, Mater Health Services, Raymond Tce, South Brisbane, Queensland, Australia.
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Wilkinson
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis; D016208:Databases, Factual; D016640:Diabetes, Gestational / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology*; D042241:Early Diagnosis; D005260:Female; D005544:Forecasting; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D000068104:Infant Health; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods / Q000639:trends*; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: early diagnosis; gestational diabetes; glucose tolerance test; mass screening; risk factors