Gestational diabetes in a tertiary care hospital: Implications of applying the IADPSG criteria

Background: The American Diabetes Association has endorsed the International Association of Diabetes and Pregnancy Groups (IADPSG) recommendation that every pregnant woman should undergo the 75 g oral glucose tolerance test (OGTT) to screen for gestational diabetes mellitus (GDM). Purpose: To find the cost and workload implications of switching from the current two-step screening of GDM to the one-step IADPSG approach. Methods: The cost (US $) and laboratory workload units (WLU) were calculated for three possible strategies: (1) 50 g glucose screen, if positive, followed by the 100 g OGTT; (2) universal 75 g OGTT; and (3) screening with the initial fasting plasma glucose of the OGTT. Results: For the 1,101 pregnant women screened in 1 year, the cost of the three strategies was $ 31,985, $ 55,250 and $ 35,875, respectively; the laboratory burden was 28,975 WLU, 18,662 WLU and 12,215 WLU, respectively. Conclusions: Switching to the one-step, strategy 2 (IADPSG) would increase the cost by 42 % but decrease the laboratory workload by 36 % compared to the two-step, strategy 1. However, an initial screen by the fasting plasma glucose of the OGTT is the ideal strategy, both in terms of cost and laboratory workload.