Selective Screening Strategies for Gestational Diabetes: A Prospective Cohort Observational Study

الملخص EN

Aim.

We aimed to develop a prediction model for the diagnosis of gestational diabetes and to evaluate the performance of published prediction tools on our population.

Methods.

We conducted a cohort study on nondiabetic women < 26 weeks gestation at a level 1 clinic in Johannesburg, South Africa.

At recruitment, participants completed a questionnaire and random basal glucose and HbA1c were evaluated.

A 75 g 2-hour OGTT was scheduled between 24–28 weeks gestation, as per FIGO guidelines.

A score was derived using multivariate logistic regression.

Published scoring systems were tested by deriving ROC curves.

Results.

In 554 women, RBG, BMI, and previous baby ≥ 4000 g were significant risk factors included for GDM, which were used to derive a nomogram-based score.

The logistic regression model for prediction of GDM had R2 0.143, Somer’s Dxy rank correlation 0.407, and Harrell’s c-score 0.703.

HbA1c did not improve predictive value of the nomogram at any threshold (e.g,.

at probability > 10%, 25.6% of cases were detected without the HbA1c, and 25.8% of cases would have been detected with the HbA1c).

The 9 published scoring systems performed poorly.

Conclusion.

We propose a nomogram-based score that can be used at first antenatal visit to identify women at high risk of GDM.