Comparing two screening policies of gestational diabetes mellitus: The Mohammed v Training Military Hospital of Rabat (Morocco) [Comparaison de deux politiques de dépistage du diabète gestationnel: expérience de l'h?pital militaire d'instruction Mohammed V de Rabat (Maroc)]

摘要

Objectives We wanted to measure the impact of going from a two-step screening for gestational diabetes mellitus (50 g oral glucose tolerance test then 100 g OGTT) to a one-step screening 75 g OGTT (WHO's recommendations). Patients and methods A prospective study was carried out among patients who consulted between July 1st, 2008 and October 31st, 2009. The screening was performed in the first trimester if risk factors were identified and between 24 and 28 weeks of gestation (WG). Results During our period of study of 15 months, 706 pregnant women were included. The prescription of a screening test was performed in 403 women, i.e. 57% of cases. Out of the 403-screened women, 33 had gestational diabetes mellitus (GDM) i.e. a 8.2% prevalence rate. In univariate analysis, the following are considered to be risk factors: age, diabetes family history and macrosomia history in a previous pregnancy. Between 24 and 28 WG, 34.34% of the screening tests were achieved. The 75 g OGTT is prescribed in 96.2% of cases as a screening test of GDM but fasting blood glucose is still prescribed in 3.8% of cases. Also, before 12 WG, 75 g OGTT represent 64.7% of the prescribed tests. Discussion Despite the simplification of the GDM screening procedure, our work shows no significant difference of the screening rate and prevalence of GDM between our present study and the first work done in the same service (57% versus 61%, P = 0.7 and 8.2% versus 7.7%, P = 0.9). The GDM risk factors found are also identical between the two studies: age, type 2 diabetes family history and macrosomia history. Moreover, there is a statistically significant improvement in the screening age (23 ± 6.7 versus 20.9 WG ± 6.8 in the first half of 2008, P < 0.001) and the number of tests ordered during the period between 24 and 28 WG (34.34% versus 23.9% in the first half of 2008, P < 0.001). For the GDM screening tests between 24 and 28 WG, 75 g OGTT replaced the 50 g OGTT (test used in the first study), but fasting blood glucose is prescribed in 3.8% of cases knowing that normal fasting blood glucose alone done between 24 and 28 WG has a poor sensitivity and do not exclude the diagnosis of GDM (Cosson, 2006) [11]. Also, before 12 WG, 75 g OGTT represents 64.7% of the prescribed tests. However, there is to date no data to validate load testing before 24 WG. Conclusion Our comparative study revealed maintenance of low implementation of universal screening of GDM despite the simplification of the protocol. Between 24 and 28 WG, 75 g OGTT replaced the 50 g OGTT, but fasting blood glucose was still prescribed. A sensitization meeting involving all intervening persons is to be organized with proposals for corrective actions. The final objective is the systematic screening of gestational diabetes mellitus with the use of fasting blood glucose in the first trimester and the 75 g OGTT between 24 and 28 weeks of gestation.