Risk factor screening for abnormal glucose tolerance in pregnancy

Objectives: To assess the prevalence and association of frequently used scr eening risk factors for gestational diabetes mellitus (GDM) and to compare the validity and cost of universal screening with risk factor screening. Me thod: A cross-sectional survey of 768 pregnant women at greater than or equ al to 24 weeks' gestation who were attending the antenatal clinic at the Ho spital Universiti Kebangsaan Malaysia (HUKM) was made. Risk factors were de termined using a questionnaire. An abnormal oral glucose tolerance test was defined as a 2-h post-prandial blood sugar level of greater than or equal to 7.8 mmol/l. Results: A total of 191 pregnant mothers (24.9%) had GDM. Th e most commonly identified screening factors were positive family history o f diabetes mellitus (31.4%), history of spontaneous abortion (17.8%), vagin al discharge and pruritis vulvae in current pregnancy (16.0%), and maternal age greater than 35 years (14.7%). Five hundred and thirteen mothers (66.8 %) had at least one risk factor. All screening risk factors, except past hi story of diabetes mellitus in previous pregnancy and maternal age, were not significantly associated with abnormal glucose tolerance (GT). Risk factor screening gave a sensitivity of 72.2% and a specificity of 35.0%. Universa l screening would cost RM 12.06 while traditional risk factor screening wou ld cost RM 11.15 per identified case and will have missed 53 of the 191 cas es. Conclusions: Risk factor screening scored poorly in predicting GDM. Cos t analysis of universal compared with traditional risk factor screening sho wed a negligible difference. Thus universal screening appears to be the mos t reliable method of diagnosing GDM. (C) 2001 International Federation of G ynecology and Obstetrics. All rights reserved.