ABSTRACT
INTRODUCTION: The change from risk-factor-based to nearly comprehensive screening of gestational diabetes (GDM) identifies more but milder cases of the disease. The main aim of this study was to evaluate the effect of this screening policy change on neonatal outcomes and care. MATERIAL AND METHODS: A population-based register study in Finland. GDM cases during risk-factor-based (year 2006, n = 5179) and comprehensive (2010, n = 6679) screenings were identified through the Medical Birth Register. All singletons without maternal GDM or prepregnancy diabetes served as controls (n = 51 746 and n = 52 386, respectively). The main outcomes were macrosomia, neonatal hypoglycemia and the need for care in a neonatal ward. RESULTS: In the GDM group, the mean birthweight decreased between the study years from 3660 g to 3595 g and the prevalence of macrosomia from 5.6 to 4.1% even after adjustment for maternal age, parity and prepregnancy body mass index. The adjusted mean difference in birthweight between GDM and control newborns decreased from 70 to 22 g between the study years. The prevalence of neonatal hypoglycemia increased from 18.0 to 22.1% in the GDM group. However, neonatal hypoglycemia was more often treated without care in a neonatal ward. The proportion of infants treated on a neonatal ward decreased in both the GDM and control groups between the study years. CONCLUSIONS: In newborns, comprehensive GDM screening led to decreased mean birthweight and macrosomia rates, but the prevalence of neonatal hypoglycemia increased. This places substantial demands for delivery hospitals and healthcare resources.
Subject(s)
Diabetes, Gestational/diagnosis , Mass Screening , Adult , Birth Weight , Brachial Plexus Neuropathies/epidemiology , Case-Control Studies , Diabetes, Gestational/epidemiology , Female , Fetal Macrosomia/epidemiology , Finland/epidemiology , Gestational Age , Humans , Hypoglycemia/epidemiology , Infant, Newborn , Intensive Care Units, Neonatal , Patient Admission/statistics & numerical data , Pregnancy , Prevalence , Registries , Tachypnea/epidemiologyABSTRACT
OBJECTIVE: To evaluate the effect of the change in the gestational diabetes (GDM) screening policy from risk-factor based to comprehensive screening on the prevalence and type of GDM and characteristics of GDM pregnancies. DESIGN: Population-based register study in Finland. Subjects were GDM women who gave birth before (2006, n=5185) and after (2010, n=6683) the policy change. All the other women in those years without pre-pregnancy diabetes acted as controls (51â759 and 52â398 respectively). METHODS: GDM women with singleton pregnancy were identified through The Finnish Medical Birth Register by abnormal oral glucose tolerance test or initiation of insulin. Main outcome measures were prevalence of GDM (total and insulin/diet-treated), and caesarean section rate. RESULTS: The proportion of screened mothers increased from 27.5 to 51.3% and the total prevalence of GDM from 9.1 to 11.3%. This increase consisted mainly of diet-treated mothers, while the number and proportion of insulin-treated mothers decreased (21.8% vs13.3%, P<0.001). The proportion of primiparous women increased (34.5-39.4%, P<0.0001) and mean pre-pregnancy BMI decreased (28.6-28.2, P<0.001). The overall caesarean section rate remained the same but increased among women with GDM (20.8-22.1%) adjusted odds ratios being 1.22 (95% CI 1.14, 1.31) during comprehensive and 1.10 (95% CI 1.02, 1.19) during risk factor-based screening. CONCLUSIONS: The shift to comprehensive screening led to a significant increase in women with GDM, who were more often primiparous and had a lower BMI. Comprehensive screening did not perform better in diagnosing women needing insulin treatment.