title: German gynecologists' experience with a universal screening for gestational diabetes mellitus in daily practice: A qualitative study.
abstract: OBJECTIVE
  In March 2012, a universal screening for gestational diabetes mellitus (GDM) was implemented in Germany. Despite international recommendations, a two-step approach was introduced [step 1: 50-g glucose challenge test (GCT); if GCT is suspicious, step 2 follows: 75-g oral glucose tolerance test with (OGTT)]. This qualitative study aimed at examining how gynecologists administer the screening for GDM in daily practice, whether they perceive any difficulties, and whether they have suggestions for improvement.
  
  
  METHODS
  Seventeen resident gynecologists were interviewed face-to-face in semi-structured interviews. The interviews were recorded, transcribed verbatim, coded, and analyzed using qualitative content techniques.
  
  
  RESULTS
  We revealed differences in the screening administration. Three gynecologists directly offered the second step of the two-step screening (OGTT) instead of completing the first step before offering the second step. These gynecologists only conducted GCT if the woman (with statutory health insurance) was not willing to pay for OGTT. Critique concerns the late introduction of billing codes, lack of information from official institutions, unavailability of readymade syrup with 50-g glucose, and lack of information material for pregnant women.
  
  
  CONCLUSIONS
  Our results reflect that not all gynecologists appear to conduct the screening conforming to the maternity directive. However, this has to be validated in larger quantitative surveys. That some gynecologists directly conducted OGTT may fuel the discussion regarding the screening procedure. The two-step approach was already highly controversial at the time of introducing the screening because national and international organizations recommend a one-step approach. Therefore, our results are also relevant for other countries who have implemented a two-step screening and for countries planning to implement a screening.
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Diehl
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Schneider
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Bock
authors.affiliation: Department of Obstetrics, Marienkrankenhaus, Hamburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Maul
authors.affiliation: Diabetologikum Kiel, Kiel, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Kleinwechter
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Görig
keywords: Gestational diabetes mellitus; glucose tolerance test; pregnancy; prenatal care; qualitative research