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Multicenter Study
. 2021 Apr 13;21(1):298.
doi: 10.1186/s12884-021-03749-x.

Implementation of a first-trimester prognostic model to improve screening for gestational diabetes mellitus

Fieke van Hoorn  1 , Maria P H Koster  2 , Anneke Kwee  1 , Floris Groenendaal  3 , Arie Franx  1   2 , Mireille N Bekker  4 ; RESPECT 2 study group
Collaborators, Affiliations
Multicenter Study

Implementation of a first-trimester prognostic model to improve screening for gestational diabetes mellitus

Fieke van Hoorn et al. BMC Pregnancy Childbirth. .

Abstract

Background: Improvement in the accuracy of identifying women who are at risk to develop gestational diabetes mellitus (GDM) is warranted, since timely diagnosis and treatment improves the outcomes of this common pregnancy disorder. Although prognostic models for GDM are externally validated and outperform current risk factor based selective approaches, there is little known about the impact of such models in day-to-day obstetric care.

Methods: A prognostic model was implemented as a directive clinical prediction rule, classifying women as low- or high-risk for GDM, with subsequent distinctive care pathways including selective midpregnancy testing for GDM in high-risk women in a prospective multicenter birth cohort comprising 1073 pregnant women without pre-existing diabetes and 60 obstetric healthcare professionals included in nine independent midwifery practices and three hospitals in the Netherlands (effectiveness-implementation hybrid type 2 study). Model performance (c-statistic) and implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability) were evaluated after 6 months by indicators and implementation instruments (NoMAD; MIDI).

Results: The adherence to the prognostic model (c-statistic 0.85 (95%CI 0.81-0.90)) was 95% (n = 1021). Healthcare professionals scored 3.7 (IQR 3.3-4.0) on implementation instruments on a 5-point Likert scale. Important facilitators were knowledge, willingness and confidence to use the model, client cooperation and opportunities for reconfiguration. Identified barriers mostly related to operational and organizational issues. Regardless of risk-status, pregnant women appreciated first-trimester information on GDM risk-status and lifestyle advice to achieve risk reduction, respectively 89% (n = 556) and 90% (n = 564)).

Conclusions: The prognostic model was successfully implemented and well received by healthcare professionals and pregnant women. Prognostic models should be recommended for adoption in guidelines.

Keywords: Clinical prediction rule; Gestational diabetes mellitus; Impact analysis; Implementation; MIDI; NoMAD; Normalization process theory; Prognostic model; Risk communication; Selective screening.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Reclassification plot of the former approach for selective screening for gestational diabetes mellitus compared to a prognostic model
Fig. 2
Fig. 2
Distribution of responses of obstetric healthcare professionals on NoMAD (a) and MIDI (b) subcontructs 6 months after the implementation of a prognostic model for gestational diabetes mellitus
Fig. 3
Fig. 3
Flowchart of testing for gestational diabetes mellitus after implementation of a prognostic model
See this image and copyright information in PMC

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