Is Risk Factor-based Screening Good Enough to Detect Gestational Diabetes Mellitus in High-Risk Pregnant Women? A Sri Lankan Experience.
BACKGROUND
There is a long lasting dilemma over the ideal screening and diagnostic method in gestational diabetes mellitus (GDM). Even though universal screening is commonly practiced, selective screening based on risk factors is also practiced in some center. The aim of this study is to evaluate the most appropriate method to screen GDM in high-risk pregnant women in Sri Lanka.


METHODS
This study was a clinic-based, cross-sectional study conducted in a tertiary referral center, Sri Lanka. All women underwent 75 g oral glucose tolerance test at 24-28 weeks of gestation. Diagnosis of GDM was made according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) criteria.


RESULTS
With universal screening using IADPSG criteria, 23.2% (105/452) were found to have GDM and with risk factor-based screening 20.1% (91/452) were detected to have GDM. The prevalence of GDM dropped to 18.1% when GDM was diagnosed using the WHO criteria with universal screening approach. It was further dropped to 15.7% when the WHO criteria were used along with risk factors-based screening approach.


CONCLUSIONS
The IADPSG criteria labeled considerably higher number of women as having GDM compared to the WHO criteria. With regards to the screening methods, the risk-based screening had a lower detection rate of GDM; however, it reduced the necessity of screening of women by around 20%.
Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
H M
HM
Meththananda Herath
Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
Thilak Priyantha
TP
Weerarathna
Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
Nayani Prasangika
NP
Weerasinghe
Gestational diabetes mellitus; International Association of the Diabetes and Pregnancy Study Groups criteria; World Health Organization criteria; universal and selective screening