The changing face of gestational diabetes: the effect of the shift from risk factor-based to comprehensive screening.
OBJECTIVE
To evaluate the effect of the change in the gestational diabetes (GDM) screening policy from risk-factor based to comprehensive screening on the prevalence and type of GDM and characteristics of GDM pregnancies.


METHODS
Population-based register study in Finland. Subjects were GDM women who gave birth before (2006, n=5185) and after (2010, n=6683) the policy change. All the other women in those years without pre-pregnancy diabetes acted as controls (51 759 and 52 398 respectively).


METHODS
GDM women with singleton pregnancy were identified through The Finnish Medical Birth Register by abnormal oral glucose tolerance test or initiation of insulin. Main outcome measures were prevalence of GDM (total and insulin/diet-treated), and caesarean section rate.


RESULTS
The proportion of screened mothers increased from 27.5 to 51.3% and the total prevalence of GDM from 9.1 to 11.3%. This increase consisted mainly of diet-treated mothers, while the number and proportion of insulin-treated mothers decreased (21.8% vs13.3%, P<0.001). The proportion of primiparous women increased (34.5-39.4%, P<0.0001) and mean pre-pregnancy BMI decreased (28.6-28.2, P<0.001). The overall caesarean section rate remained the same but increased among women with GDM (20.8-22.1%) adjusted odds ratios being 1.22 (95% CI 1.14, 1.31) during comprehensive and 1.10 (95% CI 1.02, 1.19) during risk factor-based screening.


CONCLUSIONS
The shift to comprehensive screening led to a significant increase in women with GDM, who were more often primiparous and had a lower BMI. Comprehensive screening did not perform better in diagnosing women needing insulin treatment.
Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden sanna.koivunen@oulu.fi.
Sanna
S
Koivunen
Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden.
Eero
E
Kajantie
Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden.
Annukka
A
Torkki
Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden.
Aini
A
Bloigu
Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden.
Mika
M
Gissler
Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden.
Anneli
A
Pouta
Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden Department of Obstetrics and Gynaecology and MRC OuluOulu University Hospital and University of Oulu, PO Box 23, 90029 OYS Oulu, FinlandChild and Adolescent Health and Wellbeing UnitNational Institute for Health and Welfare, PO Box 23, 90029 OYS Oulu, FinlandChronic Disease Prevention UnitNational Institute for Health and Welfare, Helsinki, FinlandChildren's HospitalHelsinki University Hospital and University of Helsinki, Helsinki, Finland andInformation DepartmentNational Institute for Health and Welfare, Helsinki, Finland and Nordic School of Public Health, Gothenburg, Sweden.
Marja
M
Vääräsmäki
D000328:Adult; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000592:standards*; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors