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Acta Obstet Gynecol Scand 2003: 82: 103--108 Printed in Denmark. All rights reserved

Copyright # Acta Obstet Gynecol Scand 2003

Acta Obstetricia et Gynecologica Scandinavica
ISSN 0001-6349


Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test


Fromthe 1Department of Women’s and Children’s Health, Uppsala University, Uppsala, and ¨ ¨ Obstetrics and Gynecology, Orebro University Hospital, Orebro, Sweden

Department of

Acta Obstet Gynecol Scand 2003; 82: 103–108.


Acta Obstet Gynecol Scand 82 2003

Background. The objective of the present study was to determine prevalence of gestational diabetes mellitus (GDM) in terms ofimpaired glucose tolerance (IGT) and diabetes mellitus (DM), and the value of traditional anamnestic risk factors for predicting outcome of the oral glucose tolerance test (OGTT). Methods. A prospective population-based study in a defined geographic area in Sweden. All pregnant nondiabetic women (n ¼ 4918) attending maternal health care from July 1994 to June 1996 were offered a 75g OGTT in gestationalweeks 28–32. Traditional anamnestic risk factors, as well as results of the OGTT in terms of fasting-B-glucose and 2h-B-glucose, were registered. ´ ´ Results. 3616 (73.5%) women agreed to perform the OGTT. Sixty-one (1.7%) of those had ´ ´ GDM [47 (1.3%) had impaired glucose tolerance and 14 (0.4%) had diabetes mel´ litus]. 15.8% fulfilled traditional risk factor criteria. Traditional anamnesticrisk factors as an indicator to perform an OGTT identified 29/61 GDM women and 9/14 women with DM. Among primiparas, 4/21 with gestational diabetes mellitus were detected. Conclusion. Using traditional risk factors as an indicator to perform an OGTT gives a low sensitivity to detect GDM and even DM especially among primiparas. Key words: gestational diabetes mellitus; screening; anamnestic riskfactor; oral glucose tolerance test Submitted 17 January, 2002 Accepted 28 January, 2002

For some decades different programs have been used in order to identify gestational diabetes mellitus (GDM). The reason for this has primarily been to reduce neonatal mortality and morbidity. The rate of GDM varies in different populations due to different screening programs as well as different diagnosticmethods (1, 2). As insulin requirement increases with advancing gestational age a small deviation in early
Abbreviations: OGTT: oral glucose tolerance test; GDM: gestational diabetes mellitus; IGT: impaired glucose tolerance test; DM: diabetes mellitus; WHO: World Health Organization; BMI: body mass index.

pregnancy could deteriorate later in pregnancy (3). Thus, early diagnosis and interventionhides the natural course of GDM in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM). However, the value of diagnoses of GDM has been questioned especially concerning IGT (4, 5). Thus it is important to determine the actual rate of DM. During the past decade there has been a European consensus on the diagnostic criteria for GDM based on the World Health Organization (WHO) 75-goral glucose tolerance test (OGTT) (6, 7). IGT is defined as a fasting B-glucose< 6.7 mmol/L and a 2h-B-glucose between 9.0–11.0 mmol/L. DM is defined as a

Acta Obstet Gynecol Scand 82 (2003)


¨ I. Ostlund & U. Hanson USA) was used for statistical analysis. For comparing group distributions, the 2-test was applied and for comparing continuous variables the Mann–Whitney U-test wasused.

fasting B-glucose !6.7 mmol/L and a 2h-B-glucose ! 11.1 mmol/L. Anamnestic risk indicators for GDM have not been evaluated against these new criteria. Because a general screening for GDM does not fulfill the WHO screening standard, the Swedish National Board of Health and Welfare in 1997 suggested that a screening for GDM should be restricted to a risk group with traditional...