Risk factor-based screening compared to universal screening for gestational diabetes mellitus in marginalized Burman and Karen populations on the Thailand-Myanmar border: An observational cohort
Issued Date
2023-01-01
Resource Type
eISSN
2398502X
Scopus ID
2-s2.0-85152941074
Journal Title
Wellcome Open Research
Volume
7
Rights Holder(s)
SCOPUS
Bibliographic Citation
Wellcome Open Research Vol.7 (2023)
Suggested Citation
Prüst J.T., Brummaier T., Wah M., Yee H.H., Win N.N., Pimanpanarak M., Min A.M., Gilder M.E., Tun N.W., Ilozumba O., Kabeer B.S.A., Terranegra A., Nosten F., Lee S.J., McGready R. Risk factor-based screening compared to universal screening for gestational diabetes mellitus in marginalized Burman and Karen populations on the Thailand-Myanmar border: An observational cohort. Wellcome Open Research Vol.7 (2023). doi:10.12688/wellcomeopenres.17743.2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82508
Title
Risk factor-based screening compared to universal screening for gestational diabetes mellitus in marginalized Burman and Karen populations on the Thailand-Myanmar border: An observational cohort
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
Sidra Medicine
University of Birmingham, College of Medical and Dental Sciences
Faculty of Medicine, Chiang Mai University
Universitat Basel
Swiss Tropical and Public Health Institute (Swiss TPH)
Nuffield Department of Medicine
Vrije Universiteit Amsterdam
Sidra Medicine
University of Birmingham, College of Medical and Dental Sciences
Faculty of Medicine, Chiang Mai University
Universitat Basel
Swiss Tropical and Public Health Institute (Swiss TPH)
Nuffield Department of Medicine
Vrije Universiteit Amsterdam
Other Contributor(s)
Abstract
Background: Gestational diabetes mellitus (GDM) contributes to maternal and neonatal morbidity. As data from marginalized populations remains scarce, this study compares risk-factor-based to universal GDM screening in a low resource setting. Methods: This is a secondary analysis of data from a prospective preterm birth cohort. Pregnant women were enrolled in the first trimester and completed a 75g oral glucose tolerance test (OGTT) at 24-32 weeks' gestation. To define GDM cases, Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO trial) criteria were used. All GDM positive cases were treated. Sensitivity and specificity of risk-factor-based selection for screening (criteria: age ≥30y, obesity (Body mass index (BMI) ≥27.5kg/m 2), previous GDM, 1 st degree relative with diabetes, previous macrosomia (≥4kg), previous stillbirth, or symphysis-fundal height ≥90th percentile) was compared to universal screening using the OGTT as the gold standard. Adverse maternal and neonatal outcomes were compared by GDM status. Results: GDM prevalence was 13.4% (50/374) (95% CI: 10.3-17.2). Three quarters of women had at least one risk factor (n=271 women), with 37/50 OGTT positive cases correctly identified: sensitivity 74.0% (59.7-85.4) and specificity 27.8% (3.0-33.0). Burman women (self-identified) accounted for 29.1% of the cohort population, but 38.0% of GDM cases. Percentiles for birthweight (p=0.004), head circumference (p=0.002), and weight-length ratio (p=0.030) were higher in newborns of GDM positive compared with non-GDM mothers. 21.7% (75/346) of newborns in the cohort were small-for-gestational age (≤10 th percentile). In Burman women, overweight/obese BMI was associated with a significantly increased adjusted odds ratio 5.03 (95% CI: 1.43-17.64) for GDM compared with normal weight, whereas in Karen women, the trend in association was similar but not significant (OR 2.36; 95% CI 0.95-5.89). Conclusions: Risk-factor-based screening missed one in four GDM positive women. Considering the benefits of early detection of GDM and the limited additional cost of universal screening, a two-step screening program was implemented.