[Relevance of gestational diabetes mellitus screening and comparison of selective with universal strategies].

OBJECTIVES

To assess the relevance of gestational diabetes mellitus (GDM) screening policy and to compare selective with universal screening.

METHODS

Systematic review of all French and English languages publications in Medline and Cochrane Databases, published since 1990.

RESULTS

Maternal hyperglycemia is associated with increased maternal and neonatal complications. The 75 g OGTT (Oral Glucose Tolerance Test) is a valid and reliable test for GDM diagnosis. Treatment of GDM reduces perinatal complications. Selective screening allows to limit false positive rate and to concentrate medical resources. Nevertheless, screening might be more difficult to perform and lead to miss up to 45% of GDM cases. Universal screening offers higher sensitivity but leads to more therapeutic interventions whose benefit and cost/efficiency ratio need to be estimated in low risk women.

CONCLUSION

The benefits of GDM screening and treatment have only been proven for women with GDM risk factors. Their relevance in women without risk factor remains controversial.