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First prenatal visit glucose screening
P L Hong1, F Benjamin, S Deutsch
1Department of Obstetrics and Gynecology, Queens Hospital Center, Jamaica, New York.
Insights
Early glucose screening during pregnancy benefits all women, including younger mothers and those under 24 weeks gestation. Universal screening aids in the timely diagnosis of gestational diabetes, proving cost-effective.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Public Health
Background:
- Gestational diabetes mellitus (GDM) is a significant pregnancy complication.
- Current screening protocols often vary based on gestational age and maternal age.
- Early detection and management of GDM are crucial for maternal and fetal health.
Purpose of the Study:
- To evaluate the efficacy of glucose screening at various gestational and maternal ages.
- To determine the benefits of earlier universal glucose screening for GDM detection.
- To assess the cost-effectiveness of universal versus age-restricted screening protocols.
Main Methods:
- A prospective study involving 999 pregnant patients.
- Nonfasting oral 50 gm glucose load followed by 1-hour serum glucose determination.
- 3-hour oral glucose tolerance test for elevated screening results (≥130 mg/dl).
- Analysis of screening results based on gestational age (<14, 14-23, 24-28, >28 weeks) and maternal age (<24 vs. ≥24 years).
Main Results:
- Younger women (<24 years) had significantly lower mean screening glucose values.
- Despite lower values, 13% of diagnosed GDM cases were in women under 24.
- 33% of positive screening tests occurred before 24 weeks gestation.
- The cost of universal screening was only slightly higher than age-restricted protocols.
Conclusions:
- Earlier glucose screening, irrespective of maternal or gestational age, facilitates earlier GDM diagnosis.
- Universal screening protocols are recommended for improved GDM detection rates.
- Implementing universal screening is a cost-effective strategy for managing GDM.
Abstract:
In order to determine the benefit of glucose screening at different stages of pregnancy, a prospective study of 999 patients was performed. All the patients underwent a nonfasting glucose screen at their first prenatal visit. This screen consisted of an oral 50 gm glucose load followed by a 1 hour serum glucose determination. If the glucose result was 130 mg/dl or higher, a 3-hour oral glucose tolerance test was performed at that time. There were 228, 354, 122, and 295 patients with gestational ages less than 14 weeks, 14 to 23 weeks, 24 to 28 weeks, and more than 28 weeks, respectively. The group less than 24 years of age had a significantly lower mean screening glucose value (106.1 +/- 35.9 mg/dl) than the group whose age was 24 years or older (117.4 +/- 35.9 mg/dl). There were significantly fewer patients with elevated screening glucose values when the patients were less than 24 years of age. Nevertheless, in the final analysis, 13% of the gestational diabetics diagnosed were in the age group younger than 24 years. Although the majority of the diagnosed gestational diabetic had elevated screening glucose values after 23 weeks of gestation, 33% had positive screening tests before 24 weeks. Earlier glucose screening, regardless of maternal age or gestational age, can lead to an earlier diagnosis of gestational diabetes. Cost of universal screening, regardless of maternal age, is only slightly more expensive than a screening protocol with a minimum age limit.