NICE targeted screening to identify gestational diabetes: who are we missing?
Keywords:gestational diabetes, screening, diagnosis, diabetes, glucose, hyperglycaemia
Background: Women with gestational diabetes (GDM) are at increased risk of perinatal complications. NICE currently recommends targeted screening of high-risk pregnant women. Our hospital’s diagnostic pathway for GDM has changed from universal screening (glucose challenge test followed by oral glucose tolerance test) to NICE-recommended targeted screening.
Aims: We investigated whether women who would be missed by a targeted screening protocol had adverse clinical outcomes.
Methods: We reviewed the electronic records of all women with GDM who delivered between April and October 2016, during a period of universal screening. Treatment and birth outcomes were compared between those with NICE risk factors (RF) and those with no risk factors (NoRF). Differences were assessed using χ2 tests.
Results: 92 women with GDM gave birth during the six months studied. 32 (35%) had no risk factors and would not currently be diagnosed with GDM. There was a significant difference in treatment between the NoRF and RF groups (p=0.003). More women in the NoRF group were managed on diet and exercise alone (53% vs. 40%) and fewer NoRF women required insulin therapy (19% vs. 45%). Delivery events were similar in the two groups (p=0.23). Fewer women in the NoRF group had macrosomia (birth weight >4000 g) (NoRF n=1 (3.1%) vs. RF n=5 (8.3%)). Admissions to the special care baby unit, predominantly for neonatal hypoglycaemia (capillary blood glucose <2.2 mmol/L), were greater in the NoRF group (NoRF n=7 (21.9%) vs. RF n=5 (8.3%)). No stillbirths or shoulder dystocia occurred in either group.
Conclusions: Targeted screening for GDM using NICE guidelines would have missed over a third of women with GDM. Although women in the NoRF group required less pharmacological treatment, they had adverse maternal and fetal outcomes equivalent to those of women with RF. Our results support universal screening of GDM.
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