Recent national and international guidelines have recommended screening for maternal dysglycaemia prior to 24 weeks gestation in ‘high-risk’ women, not previously known to have glucose abnormalities, to improve pregnancy outcomes. We assessed the level of adherence to these guidelines among women subsequently diagnosed with gestational diabetes (GDM) in a Victorian tertiary centre.
All women with GDM attending a tertiary antenatal clinic between September 2011 and August 2013 were analysed retrospectively. An interim analysis of 438 women is presented here. Women at “high risk” of dysglycaemia were defined as women who had at least one high risk factor (previous GDM; previously elevated blood glucose level; maternal age ≥ 40 years; family history of DM; BMI > 35kg/m2; previous macrosomia; polycystic ovarian syndrome; or use of corticosteroids/antipsychotics) or two moderate risk factors (BMI 25-35kg/m2 and one of the following ethnicity: Asian/Indian/Middle Eastern/African/Aboriginal/Torres Strait Islander/Pacific Islander/Maori).
360 of 438 (82%) women with GDM had either ≥ 1 major risk factor (306/360) or two moderate risk factors (54/360). However, only 145/360 (40%) of these women were tested prior to 24 weeks gestation. Additionally, 7 women who were diagnosed with early GDM fell outside the current criteria for early testing.
The uptake of the current diagnostic guidelines for GDM has been slow. In this interim analysis, approximately 60% of women with gestational diabetes deemed “high risk” for dysglycaemia were not tested prior to 24 weeks gestation as per current guideline recommendations. Strategies to increase adherence to guideline based recommendations need to be implemented. Furthermore, current criteria for early testing excludes some women with early dysglycaemia.