title: Compliance with National Institute of Health and Care Excellence risk-based screening for Gestational Diabetes Mellitus in nulliparous women.
abstract: OBJECTIVE
  To investigate compliance with risk-based screening for Gestational Diabetes Mellitus (GDM) in a nulliparous cohort.
  
  
  METHODS
  A retrospective analysis of nulliparous women recruited to a prospective cohort, the Screening for Pregnancy Endpoints (SCOPE) study, was performed. Population included 2428 healthy nulliparous women with singleton pregnancies, recruited within Cork, Ireland; and Manchester, Leeds and London, United Kingdom. Compliance with risk factor screening for GDM was assessed in relation to the following risk factors: obesity, family history of diabetes and increased ethnic risk. GDM was diagnosed using an oral Glucose Tolerance Test (GTT) with locally employed diagnostic criteria. Statistical analysis was performed using Statistical Packages for Social Sciences (SPSS V22). Descriptive statistics are presented for the various baseline characteristics using numbers and percentages. Cross tabulation was used to compare relevant groups. When comparing group distributions Chi-square test was used. p-value <0.05 was considered statistically significant.
  
  
  RESULTS
  In the entire cohort of 2432 women, 27% (650 Women) had one or more identifiable risk factors as defined by National Institute of Health and Care Excellence (NICE) for GDM. Of those that had identifiable GDM risk factors according to the NICE guidelines, 395(60.8%) were appropriately screened. 253 (38.9%) had risk factors but were not screened. 261 (14.6%) had no GDM NICE risk factors but were screened with an oral GTT. Women with a risk factor that were screened with a GTT had an 8.9% (n=34) prevalence of GDM. Of those that were screened but did not have a risk factor 7.7% (n=20) were diagnosed with GDM. Overall, 2% (54 women) of the cohort had a diagnosis of GDM. Ethnicity was the risk factor most likely to be missed (n=55, 66.3%). The GTT test was completed within the recommended gestational window (24-28 weeks) 56.6% (n=371) of the time.
  
  
  CONCLUSIONS
  This study highlights poor compliance with risk factor screening for GDM in nulliparous women. Further investigation into the underlying reasons is warranted as well as the implications for pregnancy outcome.
  
  
  BACKGROUND
  ACTRN12607000551493.
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland. Electronic address: Nicolai.murphy@ucc.ie.
authors.forename: Nicolai M
authors.initials: NM
authors.lastname: Murphy
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland and Division of Women's Health, Women's Health Academic Centre, King's College London, and King's Health Partners, United Kingdom.
authors.forename: Fergus P
authors.initials: FP
authors.lastname: McCarthy
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Ireland and The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Khashan
authors.affiliation: University of Manchester, Maternal & Fetal Health Research Centre, St Mary's Hospital, Manchester, United Kingdom.
authors.forename: Jenny E
authors.initials: JE
authors.lastname: Myers
authors.affiliation: Division of Women's and Children's Health, The University of Leeds, Leeds, United Kingdom.
authors.forename: Nigel A B
authors.initials: NA
authors.lastname: Simpson
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Ireland.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Kearney
authors.affiliation: National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork, Ireland.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Greene
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, King's College London, and King's Health Partners, United Kingdom.
authors.forename: Lucilla
authors.initials: L
authors.lastname: Poston
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Kenny
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000453:epidemiology; D042241:Early Diagnosis; D005260:Female; D005951:Glucose Tolerance Test; D019983:Guideline Adherence; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: Compliance; Gestational diabetes; Pregnancy; Risk factor; Screening