Screening for gestational diabetes in Tuscany, Italy. A population study. (October 2017)

• Record Type: Journal Article
• Authors: Di Cianni, Graziano; Gualdani, Elisa; Berni, Cecilia; Meucci, Alessandra; Roti, Lorenzo; Lencioni, Cristina; Lacaria, Emilia; Seghieri, Giuseppe; Francesconi, Paolo
• Is Part Of: Diabetes research and clinical practice. Volume 132(2017)
• Page Start: 149
• Page End: 156
• Publication Date: 2017-10
• Subjects: Gestational diabetes -- Screening -- OGTT -- Prevalence -- Population study; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.08.003
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: OGTT is currently carried out in about 80% of pregnant women in Tuscany, Italy. Many non-eligible women and several non-tested women were eligible for screening. GDM rate, as assessed by an algorithm, was high enough even in non-eligible women. Present data suggest need of universal glucose screening to identify all GDM cases. Abstract: Aims: According to current Italian guidelines, only women at higher risk of gestational diabetes (GDM) are eligible for receiving a glucose tolerance test (OGTT) during pregnancy. This study evaluates the compliance to national guidelines, additionally proposing an algorithm able to identify women with GDM. Methods: The study included 23, 270 pregnant women aged >15 yr, resident in Tuscany, a region in central Italy, delivering in year 2015, identified by certificates of care at delivery. Eligibility to screening was evaluated by fulfillment to regional guidelines recommending a 2-h-75 g-OGTT only in presence of risk factors. Additionally, a validated algorithm is proposed to diagnose GDM from regional administrative databases. Results: Glucose tolerance was tested in 79.2% of women. Eligibility criteria were fulfilled in 55.6% of OGTT performers and in 40.2% of those who didn't perform any OGTT. Performers' rate increased with age, body weight, higher education degree and in those followed by a well defined clinical setting. Housewives and students had a lower chance of receiving an OGTT. Algorithm identified GDM in 11% of women, ranging from 14% among eligible and 7% among non-eligible ones. Conclusion: Selective screening for GDM is not being currently applied in Tuscany. Despite the percentage of eligible women by national guidelines was 55%, the rate of those who performed the screening was about 80%, with a 40% of low risk women continuing to be screened. Moreover, GDM rate, calculated by algorithm, was relatively large (7%) among non-eligible women, suggesting the need of universal glucose screening to adequately capture all GDM cases.