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

Abstract

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

Methods: Systematic review of all French and English language publications in the Medline and Cochrane Databases, published since 1990.

Results: Maternal hyperglycaemia is associated with increased maternal and neonatal complications. The 75g OGTT (Oral Glucose Tolerance Test) is a valid and reliable test for GDM diagnosis. Treatment of GDM reduces perinatal complications. Selective screening helps limit false positive rates and concentrate medical resources. Nevertheless, screening could be more difficult and lead to missing up to 45% of GDM cases. Universal screening offers higher sensitivity but leads to more therapeutic interventions whose benefit and cost/effectiveness 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.