Universal screening strategy for gestational diabetes mellitus: The experience of Tawam Hospital

To estimate the prevalence of gestational diabetes mellitus (GDM) and impaired glucose tolerance test (IGTT) in an Emirate population, study the incidence of various risk factors among patients with GDM and IGTT and evaluate the effectiveness of the universal screening for GDM in comparison with selective screening based on risks factors. We reviewed the data of all pregnant women who were diagnosed to have GDM or IGTT and delivered at Tawam Hospital, United Arab Emirates, between January 1 and December 31, 2005. Risk factors for GDM were reported as: (1) family history of diabetes mellitus (DM) in parents or siblings, (2) GDM or IGTT in previous pregnancy (3) pre-pregnancy body mass index of ≥ 27 kg/m2, (4) previous delivery of macrosomic baby, (5) glucosuria, (6) previous unexplained intrauterine foetal death, (7) current polyhydraminos. The proportion of women without any risk factors was measured to assess the proportion of GDM patients who could be missed by selective screening. Out of 3650 women delivered during that period 268 had GDM and 44 had IGTT. Considering that only 82.3% of our pregnant women underwent screening for GDM, the prevalence was 8.9% (SE 0.5) for GDM and 1.4% (SE 1.2) for IGTT. Pre-pregnancy BMI ≥ 27kg/m2, family history of DM and previous GDM or IGTT were the commonest risk factors in the study subjects. Selective screening could miss 12.3% of women with GDM and 18.2% with IGTT. 15.2% of those with GDM needed insulin therapy. In conclusion the prevalence of GDM and IGTT is 8.9% (SE 0.5) and 1.4% (SE 1.2) respectively, obesity, family history previous GDM or IGTT were the commonest risk factors. Universal screening should be favored over selective screening for detection of gestational diabetes mellitus in such a high-risk population.