Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Sep 9:14:317.
doi: 10.1186/1471-2393-14-317.

Evaluation of the impact of universal testing for gestational diabetes mellitus on maternal and neonatal health outcomes: a retrospective analysis

Diane Farrar  1 , Lesley Fairley, John Wright, Derek Tuffnell, Donald Whitelaw, Debbie A Lawlor
Affiliations

Evaluation of the impact of universal testing for gestational diabetes mellitus on maternal and neonatal health outcomes: a retrospective analysis

Diane Farrar et al. BMC Pregnancy Childbirth. .

Abstract

Background: Gestational diabetes (GDM) affects a substantial proportion of women in pregnancy and is associated with increased risk of adverse perinatal and long term outcomes. Treatment seems to improve perinatal outcomes, the relative effectiveness of different strategies for identifying women with GDM however is less clear.This paper describes an evaluation of the impact of a change in policy from selective risk factor based offering, to universal offering of an oral glucose tolerance test (OGTT) to identify women with GDM on maternal and neonatal outcomes.

Methods: Retrospective six year analysis of 35,674 births at the Women's and Newborn unit, Bradford Royal Infirmary, United Kingdom.

Results: The proportion of the whole obstetric population diagnosed with GDM increased almost fourfold following universal offering of an OGTT compared to selective offering of an OGTT; Rate Ratio (RR) 3.75 (95% CI 3.28 to 4.29), the proportion identified with severe hyperglycaemia doubled following the policy change; 1.96 (1.50 to 2.58). The case detection rate however, for GDM in the whole population and severe hyperglycaemia in those with GDM reduced by 50-60%; 0.40 (0.35 to 0.46) and 0.51 (0.39 to 0.67) respectively. Universally offering an OGTT was associated with an increased induction of labour rate in the whole obstetric population and in women with GDM; 1.43 (1.35 to 1.50) and 1.21 (1.00 to1.49) respectively. Caesarean section, macrosomia and perinatal mortality rates in the whole population were similar. For women with GDM, rate of caesarean section; 0.70 (0.57 to 0.87), macrosomia; 0.22 (0.15 to 0.34) and perinatal mortality 0.12 (0.03 to 0.46) decreased following the policy change.

Conclusions: Universally offering an OGTT was associated with increased identification of women with GDM and severe hyperglycaemia and with neonatal benefits for those with GDM. There was no evidence of benefit or adverse effects in neonatal outcomes in the whole obstetric population.

PubMed Disclaimer

References

    1. Hong J, Chadha Y, Donovan T, O’Rourke P. Fetal macrosomia and pregnancy outcomes. Aust N Z J Obstet Gynaecol. 2009;49(5):504–509. doi: 10.1111/j.1479-828X.2009.01052.x. - DOI - PubMed
    1. Stotland NE, Caughey AB, Breed EM, Escobar GJ. Risk factors and obstetric complications associated with macrosomia. Int J Gynecol Obstet. 2004;87(3):220–226. doi: 10.1016/j.ijgo.2004.08.010. - DOI - PubMed
    1. Bellamy L, Casas J-P, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773–1779. doi: 10.1016/S0140-6736(09)60731-5. - DOI - PubMed
    1. Shah BR, Retnakaran R, Booth GL. Increased Risk of Cardiovascular Disease in Young Women Following Gestational Diabetes Mellitus. Diabetes Care. 2008;31(8):1668–1669. doi: 10.2337/dc08-0706. - DOI - PMC - PubMed
    1. Lawlor DA, Fraser A, Lindsay RS, Ness A, Dabelea D, Cantalano P, Davey Smith G, Sattar N, Nelson SM. Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: findings from a prospective pregnancy cohort. Diabetologia. 2010;53(1):89–97. doi: 10.1007/s00125-009-1560-z. - DOI - PubMed
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/14/317/prepub

Publication types