Universal versus selective gestational diabetes screening: Application of 1997 American Diabetes Association recommendations

OBJECTIVE: We sought to evaluate the impact of the 1997 American Diabetes A ssociation gestational diabetes mellitus screening guidelines applied to a universally screened population. STUDY DESIGN: A retrospective analysis of 18,504 women universally screened for gestational diabetes mellitus at Mayo Clinic, Rochester, between Janua ry 1, 1986, and December 31, 1997, was performed. Diabetic screening consis ted of plasma glucose determination 1 hour after a 50-g oral glucose challe nge. Diagnosis of gestational diabetes mellitus was based on National Diabe tes Data Group criteria. RESULTS: Of 564 cases of gestational diabetes mellitus diagnosed during the study period, 17 (3.0%) would have been missed under the 1997 American Dia betes Association selective screening guidelines while exempting only 10% o f this predominantly white population from screening. Screening only women greater than or equal to 25 years old would have detected 90.4% of gestatio nal diabetes mellitus cases, whereas the addition of the remaining 3 screen ing criteria combined would have detected only an additional 6.6% Or cases. CONCLUSIONS: The proportion of patients with gestational diabetes mellitus that would remain undiagnosed under the 1997 American Diabetes Association screening guidelines would be relatively small in our population. However. implementation of these guidelines would decrease the number of screens by only 10% while adding significant complexity to the screening process. Yout h appears to be the most significant protective factor for gestational diab etes mellitus in our population.