A new predictive tool for the early risk assessment of gestational diabetes mellitus.
The Italian National Institute of Health has recently introduced a selective screening based on the risk profile of pregnant women, which while recommending against screening of women at low risk (LR) for GDM, it recommends an early test for women at high risk (HR) for GDM. Herein, we assessed the accuracy and cost-effectiveness of this screening and developed a new index that improves these requirements.



We retrospectively enrolled 3974 pregnant women. GDM was diagnosed with a 2h 75-g OGTT at 16-18 weeks (early test) or 24-28 weeks of gestation, according to the IADPSG guidelines.



55.6% of HR women had GDM, although only 38.4% underwent early screening. Among 2654 women at medium risk, 20.9% had GDM; paradoxically, among 770 LR women, that would not have been screened, 26.6% received a GDM diagnosis. Based on these unsatisfactory results, we elaborated the Capula's index, that reduced both screening tests (p<0.001) and potentially undetected GDM cases (p<0.001), and corrected the paradoxical prevalence estimates of GDM obtained with the current Italian guidelines. Also, Capula's index improved correlation of GDM risk profile with obstetric and neonatal adverse events.



Capula's index improves accuracy of selective screening for GDM.
Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
Carmelo
C
Capula
Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
Eusebio
E
Chiefari
Department of Life Sciences, University of Trieste, 34127 Trieste, Italy.
Massimo
M
Borelli
Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
Rosa
R
Oliverio
Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
Anna
A
Vero
Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
Daniela
D
Foti
Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
Luigi
L
Puccio
Operative Unit of Endocrinology and Diabetes, Hospital Pugliese-Ciaccio, 88100 Catanzaro, Italy.
Raffaella
R
Vero
Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy. Electronic address: brunetti@unicz.it.
Antonio
A
Brunetti
D000328:Adult; D003362:Cost-Benefit Analysis; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D005260:Female; D005951:Glucose Tolerance Test / Q000191:economics / Q000592:standards; D017048:Health Care Costs; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011247:Pregnancy; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
Fetal complications; Gestational diabetes mellitus; Maternal complications; Screening for GDM