Literature Review of Surgical Management of First-trimester Pregnancy Loss : The Treatments and Outcomes2011

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

2014

MX4090 Research and Professionalism in Medicine I

Title:

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

Student name:NIK MUHAMMAD SYUKRI NIK HASSAN SUHAIMI

Student number:109122494

Email address:109122494@umail.ucc.ie

1931 words (Excluding Cover, Abstract, and References)TABLE OF CONTENTS

ContentsPage

Abstract3

Introduction4

Methods5

Search Results7

Discussion9

Conclusion11

References12

ABSTRACT

Aims and objectives: This literature review will look at the prevalence of Gestational Diabetes(GDM) and the type of screening program done in the health care system in different contries.

Background:For the past 20 years GDM prevalence has increased significantly in both developing and developed countries, GDM will not only post threat to the mother but the baby would also be at risk of complication such as hypoglycemia, macrosomia, type-2 DM in future life, and respiratory distress syndrome. Therefore, we need to pay more attention on the public health aspects of the increasing GDM.

Methods:Systematic library research for studies concerning the prevalence and screening program on gestational diabetes was conducted using PubMED and NCBI web database. Advance search tools used to sort journal published in between 2000 and 2014 with English language restriction.

Results and conclusion:Standards for GDM screening and management vary significantly between the countries. Both the universal and selective screening program has its advantages and disadvantages. There is limited supporting evidence to suggest one single screening program that is suitable for different populations.

An agreement on standard screening program for GDM could lead to better detection and treatment, improved outcomes for both mother and child. With GDM prevalence rates increasing in the countries studied there is an urgent need to establish a pragmatic screening program and diagnostic criteria for GDM, which are practicable, realistic and offer options that can be used in different settings at the point of care.

INTRODUCTION

Gestational diabetes mellitus (GDM) is the condition first diagnosed during pregnancy when the mother develops certain level of glucose intolerant(1). GDM may posse thret both to the mother and baby. GDM may increase the mothers risk of future diabetes, high blood pressure and pre-eclampsia. Furthermore, a mother with a history of GDM would also be more likely to developed GDM in future pragnancies. GDM would also affect the baby, baby may be at higher risk of macrosomia(which could lead to birth complication such as shoulder dystocia), pre-term birth, respiratory syndrome, hypoglycemia and type-2 diabetes in later life.Healthcare provide all over the world have been struggling to figure out wether GDM screening should be offered routinely for pregnant women and if so, what is the best screening program. To date, there is lack of consensus regarding the best GDM screening program. An ideal screening program should identify subjects at high risk of adverse pregnancy outcomes who would benefit most from costly management while avoiding the low risk from the burden of excessive interventions (2).

This literature review would look at the prevalence of GDM in different countries and see the types of screening program done. It will also discuss the advantages and disadvantages of the different types of screening program. Hopefully an agreement on standard screening program for GDM could lead to better detection and treatment, improved outcomes for both mother and child. With GDM prevalence rates increasing around the world there is an urgent need to establish a pragmatic screening program and diagnostic criteria for GDM which are practicable, realistic and offer options that can be used in different settings at the point of care(3). Furthermore, with uniform and cost effective screening program it will improve management treatment of women with GDM. Thus, improving the obstetrical overall outcomes.

METHODS

Literature Search strategy

Systematic library research for studies concerning effect on exercise on gestational diabetes was conducted using Pub MED web database. Advance search tools used to sort journal published in since 2000 until 2014 . For journal concerning general scientific information of gestational diabetes and its statistical data, keywords used are gestational diabetes, Ireland, Europe. For journal with regards to GDM prevalence keywords used are prevalence and gestational diabetes

Database/ SourceResults

Pub MED3573

Table 1: Different type of web based data-sources and number of paper came out as search results

Initially the total search results were 3573. Matching keywords were crosschecked for search result and selection of journal were made for most relevant journal or journal which relates to topic of interest. Detailed reviews of selected journal were made for inclusion or exclusion.

Study Selection

Inclusion criteria: Journals regarding prevalence and GDM which the full text is available. Only Journal which is available in English were selected. Journals that studies GDM Screening program.

Exclusion criteria: Non English journals. Duplicates. Free Full text not available

Total citation identified from initial search (n= 3573)

Studies included in the review (n=10)

Journals excluded after removing duplicates and irrelevance based on titles and abstracts

Potential citations reviewed for detailed evaluation (n=80)All from electronic sources

Excluded studies (n=70)Reasons for exclusion non English journal, duplicates, Full text not available.

Figure 1: Flow for article selection based on inclusion and exclusion criteria

SEARCH RESULTS

ReferenceFirst AuthorSetting(Place and Time)Type of StudyMethodPrevalenceConclusion

Sample SizeTwo Step or One Step TestUniversal/ Selective Screening

(4)Benhalima K et al.Northern Belgium2013Retrospective Cohort Study. 6727the one-step IADPSG screening strategy.Universal5.68%Using the IADPSG criteria, more women are identified as having GDM, and these women carry an increased risk for adverse gestational outcome compared to women without GDM.

(5)Cosson E et al.Eastern Suburb Paris France2002-2010Cohort Study.20630One step WHO CriteriaUniversal14.4%The presence of risk factors increased during the last decade. This condition is predictive of GDM. However, a selective screening would lead to missing one-third of the women with GDM who, even without risk factors, had more events than women without GDM.

(6)Hannah FW et al.UK2008Questionnaire--universal (52%)selective (48%) 1.5%Standards for GDM screening and management vary significantly across the UK.

(7)Jimenez-Moleon JJ et al.San Cecilio University Hospital of Granada (SCUH) , Spain.2002Retrospective cohort study.2574Two Step National Diabetes Data Group CriteriaSelective screening.ADA guideline and ACOG guideline.2.5%Selective screening might be beneficial. Nevertheless, selective gestational diabetesmellitus screening under ADA criteria seems to entail the same disadvantages as the selective screening strategies without any apparent benefits.

(8)Lindqvist M et al.Sweden2011-2012Cross sectional study184,183 4 Different Types of Two Step Test88.7%(selective)11.3%(universal)2.9% (selective)2.2%(universal)There was no consensus regarding screening regimes for GDM from 2011 through 2012 when four different regimes were applied in Sweden.

(9)Murgia C et al.Sardinia, Italy.2006Cohort Study1,103Two StepSelective Screening according to the ADA guideline22.3%The differencein prevalence of GDM between our groupand others, particularly other Italian regions,is only partially explainable by our extended screening procedure.

(10)Pedersen et al.GreenLand2008Retrospective Cohort study233-Selective Screening Program4.3%Despite a suboptimal screening rate, the prevalence of GDM among Greenlanders seems to be relatively low and Greenlanders may thus be less prone to develop GDM.

(11)Sella t et al.Israel 2000-2010

Cohort Study367,247--4.3%The increasing risk of GDM in Israel can be explained by both rising prevalence of women with established risk factors, as well as shifting screening practices.

(12)OSullivan et al.Irish Atlantic Seaboard

Cohort Study-the one-step IADPSG screening strategy.Universal12.4%With rising obesity levels and older age of mothers, both risk factors for GDM, these results would support a national universal screening programme.

(13)Orechhio A et al.SwitzerlandCohort Study10422 Step Screening Program-4.8%Incidence of GDM and GGI as well as birth complications resulted significant in our country.

Table 2: Papers reviewed in this literature.DISCUSSIONS

This literature review looks at the different types of Screening program and prevalance of Gestational Diabetes(GDM) in different countries.

All relevant study; found on the web search are listed in Table 2. From all 10 journals selected, 8 of it were Cohort studies, 1 cross-sectional studies and 1 questionnaire based study. Retrospective studies involved could mean a drawback of underreporting due to poor documentation.

Section 1: Prevelance of GDM.Prevalence of GDM is known to vary widely between populations, it depends on the socio-economic status, region of the country and dietary patterns(14). In this review, the prevalence of GDM varies between countries varying from 1.5% to 22.3%, with the mean of 7.0%,the lowest prevalence stated in a study done in the UK(6) and highest in a study done in Sardinia, Italy(9). The high prevelence of GDM in Sardinia Itlay is mostly due to extended screening procedure(9). The increasing prevalence of most countries is associated with increasing prevalence of its risk factors such as obesity, low levels of physical activity and changes in dietary habits(4, 5, 7, 9, 11-13). For a pragmatic planning and management as well as the preventive strategies, the data of prevalence of GDM and the prevalence of its risk factors are very important.

Section 2: GDM Screening.An ideal screening program should identify subjects at high risk of adverse pregnancy outcomes who would benefit most from costly management while avoiding the low risk from the burden of excessive interventions. (2)

One Step v.s. Two Step.Most journals (7-11, 13) in this review adopts the usual two step screening program, as advise by most organization such as the American College of Obstetricians and Gynecologists (15) and National Institute of Health(16).

Two journal studies the one-step the screening program that adopts the recent recommendations of the International Association of Diabetes and Pregnancy Study Group (IADPSG). In (4) only one-fourth of centers have implemented the one-step IADPSG screening strategy. Where in one study, it concluded that the IADPSG screening method is cost-effective. The model is most sensitive to the likelihood of preventing future diabetes in patients identified with GDM using post-delivery counseling and intervention(17). However, the IADPSG screening strategy remains controversial, studies shows a high inconsistency of adverse effect of pregnancy outcomes and cost-effectiveness analyses show conflicting results (18).

Universal v.s. Selective.Universal screening for gestational diabetes remains controversial. In the UK 52% of healthcare centers adopts the universal screening program(6). Universal screening that is recommended by many healthcare organizations will lead to high false positive, labeling a large number of having GDM, without differentiating between those at low and those at high risk of pregnancy complications. (15) Internationally recommended method of universal screening for GDM should be consider wisely, which minimizes the cost for the healthcare system and individual cost, yet provides diagnostic efficacy.(19)

Both the National Institute for Health and Clinical Excellence the American Diabetes Association (20) and the International Diabetes Federation recommend selective screening for gestational diabetes. In Europe, a selective GDM screening is still the most common approach (8, 21, 22), except for the UK(6). In one study done in Spain, suggest that selective screening might be beneficial where GDM was found to be approximately six times lower among low-risk gravidae than among the high-risk subjects.(7) However in one data stand against the present selective screening, where a selective screening would lead to missing one-third of the women with GDM who, even without risk factors, had more events than women without GDM.(5) Furthermore, one of the limitation of selective screening is that it is more complex than universal screening and its implementation adds an additional burden to the health care provider.

The sensible way in applying the selective screening program would mostly relies on the prevalence of risk factors in the screened population. For example, if the screened population is largely of women with no risk factor, then many women would be spared from screening. On the contrary, in a population mostly of overweight with additional risk factors applying selective screening program will likely lead to the majority of women being screened. For example in India with a high prevalence of diabetes universal screening, instead of selective screening, for GDM is ideal.(23) Even when a test is capable of detecting GDM accurately, in a low prevalence population the benefits of identifying and treating cases can be outweighed by the costs of doing so. (24)

CONCLUSION

Standards for GDM screening and management vary significantly between the countries. Both the universal and selective screening program has its own advantages and disadvantages. There is limited supporting evidence to suggest one single screening program that is suitable for all different populations.

An agreement on standard screening program for GDM could lead to better detection and treatment, improved outcomes for both mother and child. With GDM prevalence rates increasing in the countries studied there is an urgent need to establish a pragmatic screening program and diagnostic criteria for GDM, which are practicable, realistic and offer options that can be used in different settings at the point of care(3).

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Diagnostic and prognostic performances over 9 years of a selective screening strategy for gestational diabetes mellitus in a cohort of 18,775 subjects. Diabetes care. 2013;36(3):598-603.6.Hanna FW, Peters JR, Harlow J, Jones PW. Gestational diabetes screening and glycaemic management; national survey on behalf of the Association of British Clinical Diabetologists. QJM : monthly journal of the Association of Physicians. 2008;101(10):777-84.7.Jimenez-Moleon JJ, Bueno-Cavanillas A, Luna-Del-Castillo JD, Garcia-Martin M, Lardelli-Claret P, Galvez-Vargas R. Prevalence of gestational diabetes mellitus: variations related to screening strategy used. European journal of endocrinology / European Federation of Endocrine Societies. 2002;146(6):831-7.8.Lindqvist M, Persson M, Lindkvist M, Mogren I. No consensus on gestational diabetes mellitus screening regimes in Sweden: pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study. BMC pregnancy and childbirth. 2014;14(1):185.9.Murgia C, Berria R, Minerba L, Malloci B, Daniele C, Zedda P, et al. Gestational diabetes mellitus in Sardinia: results from an early, universal screening procedure. Diabetes care. 2006;29(7):1713-4.10.Pedersen ML, Jacobsen JL, Jorgensen ME. Prevalence of gestational diabetes mellitus among women born in Greenland: measuring the effectiveness of the current screening procedure. International journal of circumpolar health. 2010;69(4):352-60.11.Sella T, Shalev V, Elchalal U, Chovel-Sella A, Chodick G. Screening for gestational diabetes in the 21st century: a population-based cohort study in Israel. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2013;26(4):412-6.12.O'Sullivan EP, Avalos G, O'Reilly M, Dennedy MC, Gaffney G, Dunne F, et al. Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetologia. 2011;54(7):1670-5.13.Orecchio A, Periard D, Kashef A, Magnin JL, Hayoz D, Fontana E. Incidence of gestational diabetes and birth complications in Switzerland: screening in 1042 pregnancies. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 2014:1-4.14.Rajput M, Bairwa M, Rajput R. Prevalence of gestational diabetes mellitus in rural Haryana: A community-based study. Indian journal of endocrinology and metabolism. 2014;18(3):350-4.15.American College of O, Gynecologists Committee on Practice B-O. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. 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109122494 | NIK MUHAMMAD SYUKRI1