Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya: a prospective comparison of point of care diagnostic methods

BMC Pregnancy and Childbirth

Research Article

Ponnusamy Saravanan¹  Astrid Christoffersen-Deb²  Sonak D. Pastakia³  Benson Njuguna⁴  Beryl Ajwang’ Onyango⁴  Sierra Washington⁵  Wycliffe K Kosgei⁶ 

[1] Department of Diabetes, Endocrinology & Metabolism, Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK;Diabetes and Endocrine Centre, George Eliot Hospital, CV107DJ, Nuneaton, UK;Department of Obstetrics & Gyneacology, University of Toronto, M5G 1E2, Toronto, ON, Canada;Department of Pharmacy Practice, Purdue Kenya Partnership, PO Box 5760, 30100, Eldoret, Kenya;Department of Pharmacy, Moi Teaching and Referral Hospital, PO Box 3, 30100, Eldoret, Kenya;Department of Reproductive Medicine, University of California, 92103, San Diego, CA, USA;Division of Reproductive Health, Moi Teaching and Referral Hospital, PO Box 3, 30100, Eldoret, Kenya;

关键词: Gestational diabetes mellitus;    Screening;    Prevalence;    Diagnosis;    Low middle income;   

DOI  :  10.1186/s12884-017-1415-4

 received in 2016-12-09, accepted in 2017-07-05,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundEarly diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting.MethodsEligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference.ResultsSix hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity.ConclusionsPOC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify sensitive and specific POC GDM screening strategies using adverse pregnancy outcomes as end points are required.Trials registrationClinical trials.gov: NCT02978807, Registered 29 November 2016.

【 授权许可】

CC BY   
© The Author(s). 2017