Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome

Aims Gestational diabetes mellitus (GDM) is associated with adverse materna l and fetal outcome. Screening for GDM is therefore recommended bur the bes t screening method remains controversial. This prospective, randomized stud y compared a risk factor-based screening programme with a universally based one. Methods Subjects were randomized at booking to one of two groups: the risk factor group had a 3-h 100-g oral glucose tolerance test (OGTT) at 32 weeks if any risk factor for GDM was present; the universal group had a 50-g glu cose challenge test performed and if their plasma glucose at 1 h was greate r than or equal to 7.8 mmol/l, a formal 3-h 100-g OGTT was then performed. Results Universal screening detected a prevalence of GDM of 2.7%, significa ntly more than the 1.45% detested in the risk factor screened group (P < 0. 03). Universal screening facilitated earlier diagnosis than risk factor scr eening - mean gestation 30 +/- 2.6 weeks vs. 33 +/- 3.7 weeks (P < 0.05). A higher rate of spontaneous vaginal delivery at term, and lower rates of ma crosomia, Caesarean section, prematurity, pre-eclampsia and admission to ne onatal intensive care unit were observed in the universally screened, early diagnosis group. Conclusions Universal screening for GDM. is superior to risk factor based s creening - detecting more cases, facilitating early diagnosis and is associ ated with improved pregnancy outcome.