Performance of a selective screening strategy for diagnosis of hyperglycaemia in pregnancy as defined by IADPSG/WHO criteria.

E Cosson, E Vicaut, D Sandre-Banon, F Gary, I Pharisien, J-J Portal, C Baudry, C Cussac-Pillegand, D Costeniuc, P Valensi, L Carbillon

Journal: Diabetes & metabolism 2021;46(4):311-318

PMID: 31672576

Full Text on Elsevier Science View on PubMed

Abstract

AIM

Our study evaluated the performance of a selective screening strategy for hyperglycaemia in pregnancy (HIP) based on the presence of risk factors (RFs; body mass index≥25kg/m, age≥35years, family history of diabetes, personal history of HIP or macrosomic infant) to diagnose HIP and to predict HIP-related events.

METHODS

Women with no known diabetes who had undergone complete universal screening (early, before 22weeks of gestation and, if normal, in the second part of pregnancy) at our department (2012-2016) were selected, resulting in four groups of women according to the presence of HIP and/or RFs, with a predefined composite endpoint (preeclampsia or large-for-gestational-age infant or shoulder dystocia).

RESULTS

Included were 4518 women: 23.5% had HIP and 71.1% had at least one RF. The distribution among our four groups was: HIP-/RF- (n=1144); HIP-/RF+ (n=2313); HIP+/RF- (n=163); and HIP+/RF+ (n=898). HIP was more frequent when RFs were present rather than absent (33.1% vs 15.4%, respectively; P<0.001). Incidence of the composite endpoint differed significantly (P<0.0001) across groups [HIP-/RF- 6.3%; HIP-/RF+ 13.2%; HIP+/RF- 8.6%; and HIP+/RF+ 17.1% (HIP effect: P<0.05; RF effect: P<0.001; interaction HIP * RF: P=0.94)] and significantly increased with the number of RFs (no RF: 6.3%, 1 RF: 10.8%, 2 RFs: 14.7%, 3 RFs: 28.0%, 4-5 RFs: 25.0%; P<0.0001).

CONCLUSION

RFs are predictive of HIP, although 15.4% of women with HIP have no RFs. Also, irrespective of HIP status, RFs are predictive of HIP-related events, suggesting that overweight/obesity, the only modifiable RFs, could be targets of interventions to improve pregnancy prognosis.

Address: Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93143 Bondy, France; Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM, U11125 INRA CNAM, Université Paris 13, Unité de Recherche Épidémiologique Nutritionnelle, 93000 Bobigny, France. Electronic address: [email protected].; Université Denis-Diderot, AP-HP, Unité de Recherche Clinique Saint-Louis-Lariboisière, 75010 Paris, France.; Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93143 Bondy, France.; Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Obstetrics and Gynecology, 93143 Bondy, France.

DOI: 10.1016/j.diabet.2019.09.002

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MeSH Terms: Adult, Cesarean Section, Diabetes, Gestational, Female, Fetal Macrosomia, France, Gestational Weight Gain, Glucose Tolerance Test, Humans, Intensive Care Units, Neonatal, Maternal Age, Medical History Taking, Pregnancy in Obesity, Pre-Eclampsia, Pregnancy, Pregnancy in Diabetics, Premature Birth, Prenatal Diagnosis, Respiratory Distress Syndrome, Newborn, Risk Assessment, Risk Factors, Shoulder Dystocia