Fasting glycaemia to simplify screening for gestational diabetes

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Clinical Diagnostics

Background:

• Gestational diabetes mellitus (GDM) screening recommendations in Switzerland align with the International Association of Diabetes in Pregnancy Study Group (IADPSG) consensus.
• Universal screening via glucose tolerance testing is time-consuming and involves an unpleasant glucose load for patients.

Purpose of the Study:

• To evaluate the diagnostic performance of a simplified GDM screening strategy.
• To compare the simplified strategy with the complete 75-g oral glucose tolerance test (OGTT) in a low-prevalence population.

Main Methods:

• A retrospective analysis of 2298 complete 75-g OGTTs was performed.
• A simplified screening approach was simulated, omitting the glucose load if fasting glycaemia was <4.4 mmol/l or ≥5.1 mmol/l.

Main Results:

• The simplified strategy, performing the full OGTT only for fasting glycaemia between 4.4 and <5.1 mmol/l, achieved a sensitivity of 78.5%.
• This approach would have avoided the complete glucose load for 63.8% of pregnant women.
• The prevalence of GDM in the study population was 10.9%.

Conclusions:

• Screening based on fasting glycaemia presents an attractive, less burdensome alternative to universal 75-g OGTT for GDM detection.
• While effective, this simplified strategy demonstrates slightly lower sensitivity compared to previous reports in higher-risk populations.