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Is Risk Factor‑based Screening Good Enough to Detect Gestational Diabetes Mellitus in High‑Risk Pregnant Women? A Sri Lankan Experience
Abstract
Background: There is a long lasting dilemma over the ideal screening and diagnostic method
in gestational diabetes mellitus (GDM). Even though universal screening is commonly practiced,
selective screening based on risk factors is also practiced in some center. The aim of this
study is to evaluate the most appropriate method to screen GDM in high‑risk pregnant women
in Sri Lanka.
Methods: This study was a clinic‑based, cross‑sectional study conducted in a tertiary referral
center, Sri Lanka. All women underwent 75 g oral glucose tolerance test at 24–28 weeks
of gestation. Diagnosis of GDM was made according to the International Association of the
Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO)
criteria.
Results: With universal screening using IADPSG criteria, 23.2% (105/452) were found to have
GDM and with risk factor‑based screening 20.1% (91/452) were detected to have GDM. The
prevalence of GDM dropped to 18.1% when GDM was diagnosed using the WHO criteria with
universal screening approach. It was further dropped to 15.7% when the WHO criteria were used
along with risk factors‑based screening approach.
Conclusions: The IADPSG criteria labeled considerably higher number of women as having
GDM compared to the WHO criteria. With regards to the screening methods, the risk‑based
screening had a lower detection rate of GDM; however, it reduced the necessity of screening of
women by around 20%.
Keywords: Gestational diabetes mellitus, International Association of the Diabetes and Pregnancy
Study Groups criteria, universal and selective screening, World Health Organization criteria
in gestational diabetes mellitus (GDM). Even though universal screening is commonly practiced,
selective screening based on risk factors is also practiced in some center. The aim of this
study is to evaluate the most appropriate method to screen GDM in high‑risk pregnant women
in Sri Lanka.
Methods: This study was a clinic‑based, cross‑sectional study conducted in a tertiary referral
center, Sri Lanka. All women underwent 75 g oral glucose tolerance test at 24–28 weeks
of gestation. Diagnosis of GDM was made according to the International Association of the
Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO)
criteria.
Results: With universal screening using IADPSG criteria, 23.2% (105/452) were found to have
GDM and with risk factor‑based screening 20.1% (91/452) were detected to have GDM. The
prevalence of GDM dropped to 18.1% when GDM was diagnosed using the WHO criteria with
universal screening approach. It was further dropped to 15.7% when the WHO criteria were used
along with risk factors‑based screening approach.
Conclusions: The IADPSG criteria labeled considerably higher number of women as having
GDM compared to the WHO criteria. With regards to the screening methods, the risk‑based
screening had a lower detection rate of GDM; however, it reduced the necessity of screening of
women by around 20%.
Keywords: Gestational diabetes mellitus, International Association of the Diabetes and Pregnancy
Study Groups criteria, universal and selective screening, World Health Organization criteria