Screening for pregestational and gestational diabetes in pregnancy: a survey of obstetrical centers in the northern part of Belgium

Diabetology & Metabolic Syndrome

Chantal Mathieu¹  Luc De Catte²  Ann Verhaegen³  Johan Verhaeghe⁵  Roland Devlieger⁵  Paul Van Crombrugge⁴  Katrien Benhalima¹ 

[1] Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium;Chair of the obstetrical working group of the Flemish Association of Obstetrics & Gynecology (VVOG), Sint-Niklaas, Belgium;Chair of the professional working group of the Flemish Diabetes Association (VDV), Gent, Belgium;Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium;Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium

关键词: Practices;    Gestational diabetes;    Pregestational diabetes;    Screening;    Survey;   

Others  :  812573
DOI  :  10.1186/1758-5996-5-66

 received in 2013-07-15, accepted in 2013-11-09,  发布年份 2013

【 摘 要 】

Background

There is lack of consensus concerning the best screening strategy for gestational diabetes (GDM). The aim of our survey was therefore to investigate attitudes and practices of all obstetrical centers in the northern part of Belgium regarding screening for pregestational diabetes in early pregnancy and screening for GDM. We also aimed to identify the penetrance of the ‘International Association of Diabetes in Pregnancy Study Groups’ (IADPSG) screening strategy for GDM.

Methods

The survey was conducted from May 2012 till January 2013. The survey was distributed to every obstetrical center in the northern part of Belgium by email and/or mail with reminders by phone and personal contact.

Results

From the 65 obstetrical centers, 69% responded. Of all centers, 27% had a structured database on the number of women with GDM. Of all centers, 82% screened for pregestational diabetes in early pregnancy and 56% of centers screened for GDM before 24 weeks. Screening before 24 weeks was mostly based on risk factors. Screening for GDM after 24 weeks, was done universally in 87% of centers. The mean estimated prevalence of GDM was 7 ± 5%. The most commonly used screening strategy was a two-step approach with a glucose challenge test (GCT) and 100 g oral glucose tolerance test (OGTT), used by 56% of centers, with 23 centers using the Carpenter & Coustan criteria. The 75 g OGTT with the IADPSG criteria was used by 33% of centers but 4 of these centers still used a GCT before proceeding to the full OGTT.

Conclusions

This survey demonstrates that in the northern part of Belgium, there still is a large variation in screening strategy for pregestational diabetes in early pregnancy and GDM. Only 25% of centers have already implemented the one-step IADPSG screening strategy.

【 授权许可】

   
2013 Benhalima et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Lawrence JM, Contreras R, Chen W, Sacks DA: Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005. Diabetes Care 2008, 31:899-904.
• [2]Gilmartin AB, Ural SH, Repke JT: Gestational diabetes mellitus. Rev Obstet Gynecol 2008, 1:129-134.
• [3]Bellamy L, Casas JP, Hingorani AD, Williams D: Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009, 373:1773-1779.
• [4]International Association of Diabetes and Pregnancy Study Groups Consensus Panel: International association of diabetes and pregnancy study groups recommendations on the diagnostic and classification of hyperglycemia in pregnancy. Diabetes Care 2010, 33:676-682.
• [5]American Diabetes Association: Standards of Medical Care in diabetes-2013. Diabetes Care 2013, 36:S11-S66.
• [6]Committee on Obstetric Practice Screening and diagnosis of gestational diabetes mellitus Obstetrics & Gynecology 2011, 118:751-753.
• [7]Vandorsten JP, Dodson WC, Espeland MA, Grobman WA, Guise JM, Mercer BM, Minkoff HL, Poindexter B, Prosser LA, Sawaya GF, Scott JR, Silver RM, Smith L, Thomas A, Tita AT: NIH Consensus Development Conference: Diagnosing Gestational Diabetes Mellitus. NIH Consensus State Sci Statements 2013, 29:1-31.
• [8]Benhalima K for the VDV-VVOG-Domus Medica consensus group: The VDV-VVOG-Domus Medica consensus 2012 on screening for pregestational diabetes in pregnancy and screening for gestational diabetes. P Belg Roy Acad Med 2013, 2:24-42.
• [9]Vanderijst J-F, Debieve F, Doucet F, Emonts P, Haumont S, Hubinont C, Kirkpatrick C, Philips JC, Pintiaux A, Rousseau P, Senterre G, Vandeleene B, Féry F: Stratégie de dépistage et critères diagnostiques du diabète gestationnel. Propositions du GGOLFB. Rev Med Liege 2012, 67(4):179-185.
• [10]International Diabetes Federation: Update Diabetes e-Atlas 2012. 2012. http://www.eatlas.idf.org webcite
• [11]FOD Economie-Statbel. htpp://statbel.fgov.be/nl/statistieken/cijfers/bevolking/structuur
• [12]Bréart G, Barros H, Wagener Y, Prati S: Characteristics of the childbearing population in Europe. European Journal of Obstetrics, gynecology and Reproductive Biology 2003, 111(Suppl. 1):45-55.
• [13]De Vlaamse Diabetes Vereniging, het project ‘Zoet Zwanger. http://www.zoetzwanger.be webcite
• [14]Zhu W-W, Yang H-X, Wei Y-M, Yan J, Wang ZL, Li XL, Wu HR, Li N, Zhang MH, Liu XH, Zhang H, Wang YH, Niu JM, Gan YJ, Zhong LR, Wang YF, Kapur A: Evaluation of the value of fasting plasma glucose in first prenatal visit to diagnose gestational diabetes mellitus in China. Diabetes Care 2013, 36:586-590.
• [15]American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2009, 32:S62-S67.
• [16]Ogunyemi A, Fong A, Rad S, Fong S, Kjost SL: Attitudes and practices of healthcare providers regarding gestational diabetes: results of a survey conducted at the 2010 meeting of the International Association of Diabetes in Pregnancy Study Group (IADPSG). Diabet Med 2001, 28:976-986.
• [17]Jiwani A, Marseille E, Lohse N, Damm P, Hod M, Kahn JG: Gestational diabetes mellitus: results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med 2012, 25:600-610.
• [18]Doyle MA, Khan S, Al-Mohanadi D, Keely E: International survey on gestational diabetes. J Matern Fetal Neonatal Med 2012, 25:2035-2038.
• [19]Buckley BS, Harreiter J, Damm P, Corcoy R, Chico A, Simmons D, Vellinga A, Dunne F: Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review. Diabet Med 2012, 29:844-854.
• [20]The Flemish Center for the Study of Perinatal Epidemiology database. http://statbel.fgov.be/nl/modules/digibib/bevolking/1712_perinatale_activiteiten_in_vlaanderen_2011.jsp webcite
• [21]Benhalima K, Hanssens M, Devlieger R, Verhaeghe J, Mathieu C: Analysis of pregnancy outcomes using the new IADPSG recommendation compared with the Carpenter & Coustan criteria in an area with a low prevalence of gestational diabetes. Int J Endocrinology 2013. doi.org/10.1155/2013/248.121
• [22]Jenum AK, Mǿrkrid K, Sletner L, Vange S, Torper JL, Nakstad B, Voldner N, Rognerud-Jensen OH, Berntsen S, Mosdøl A, Skrivarhaug T, Vårdal MH, Holme I, Yajnik CS, Birkeland KI: Impact of ethnicity on gestational diabetes identified with the WHO and the modified IADPSG criteria: a population-based cohort study. Eur J Endocrinol 2012, 166:317-324.
• [23]Lapolla A, Dalfra M, Ragazzi E, De Cata AP, Fedele D: New International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations for diagnosing gestational diabetes compared with former criteria: a retrospective study on pregnancy outcome. Diabet Med 2011, 28:1074-1077.
• [24]The international Expert Committee: International Expert Committee Report on the role of the A1c assay in the diagnosis of diabetes. Diabetes Care 2009, 32:1327-1334.
• [25]O’Shea P, O’Connor C, Owens L, Carmody L, Avalos G, Nestor L, Lydon K, Dunne FP: Trimester-specific reference intervals for IFCC standardized haemoglobin A(1c): new criterion to diagnose gestational diabetes mellitus (GDM)? Ir Med J 2012, 105:29-31.