Research Group Epidemiology of Chronic Diseases, Institute of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
Acta Obstet Gynecol Scand. 2022 Jun;101(6):581-588. doi: 10.1111/aogs.14276. Epub 2021 Oct 26.
There are major controversies in screening for gestational diabetes mellitus (GDM). The present study evaluates the impact of the 2017 revised guidelines for GDM screening and a changed definition of GDM in Norway.
We used a case-series design and included women with no pre-pregnancy diabetes mellitus, who gave birth after gestational week 29 to a singleton fetus at the University Hospital of North Norway, Tromsø, or at a local maternity ward in Troms county, during the first 6 months of 2013 (before group, n = 676) and 2018 (after group, n = 673). Data were collected from antenatal records, maternal health information sheets, and electronic medical records (Partus). We assessed the screening criteria age, parity, pre-pregnancy BMI, and ethnicity. Primary outcomes were change in size of the population eligible for GDM screening, screening adherence, and prevalence of GDM, and follow up of GDM (treatment and obstetric risk assessment at gestational week 36). Statistical analyses were done using IBM SPSS with chi-squared test. A p value less than 0.05 was considered statistically significant.
The proportion of women eligible for GDM screening increased from 46.4% in the before group to 67.6% in the after group (+45%) (p < 0.01). However, screening adherence among eligible women was only 28.3% and 49.2% in the before and after groups, respectively (p < 0.01). Among screened women, 16.9% (15/89) and 10.7% (24/224), respectively, were diagnosed with GDM, resulting in an overall estimated prevalence of 2.2% (15/676) and 3.6% (24/673). Among women diagnosed with GDM, 13.3% received no follow up in 2013 and this proportion was 20.8% in 2018. The remaining women underwent obstetric risk assessment at gestational week 36 as advised in the guidelines.
The introduction of broader screening criteria and a more liberal case definition increased the population eligible for GDM screening by 45%. The higher proportion of women screened resulted in an insignificant higher prevalence of GDM. Screening adherence was poor in both study groups. Stakeholders for obstetric care need to consolidate quality measures and revisit the screening algorithm.
妊娠期糖尿病（GDM）的筛查存在重大争议。本研究评估了 2017 年 GDM 筛查修订指南和挪威 GDM 定义变化的影响。
我们采用病例系列设计，纳入了 2013 年 6 个月内在北挪威特罗姆瑟大学医院或特罗姆瑟县当地产科病房分娩、无孕前糖尿病的单胎孕妇，妊娠 29 周后至分娩（前组，n=676）和 2018 年（后组，n=673）。数据来自产前记录、产妇健康信息表和电子病历（Partus）。我们评估了筛查标准年龄、产次、孕前 BMI 和种族。主要结局是符合 GDM 筛查条件的人群规模变化、筛查依从性和 GDM 患病率以及 GDM 的随访（治疗和妊娠 36 周时的产科风险评估）。使用 IBM SPSS 进行统计分析，卡方检验。p 值<0.05 被认为具有统计学意义。
符合 GDM 筛查条件的女性比例从前组的 46.4%增加到后组的 67.6%（增加 45%）（p<0.01）。然而，符合条件的女性中筛查依从性仅为前组的 28.3%和后组的 49.2%（p<0.01）。在筛查的女性中，分别有 16.9%（15/89）和 10.7%（24/224）被诊断为 GDM，导致总体估计患病率分别为 2.2%（15/676）和 3.6%（24/673）。在诊断为 GDM 的女性中，2013 年有 13.3%的女性未接受随访，而 2018 年这一比例为 20.8%。其余女性按照指南建议在妊娠 36 周时进行产科风险评估。
更广泛的筛查标准和更宽松的病例定义的引入使符合 GDM 筛查条件的人群增加了 45%。更多女性接受筛查导致 GDM 的患病率略有升高。两个研究组的筛查依从性都很差。产科护理利益相关者需要整合质量措施并重新审视筛查算法。
