2014

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

MX4090 Research and Professionalism in Medicine I

Title:

Prevalence of GDM and its Screening Program in Different Countries:

A Review of The literature.

Student name:
NIK MUHAMMAD SYUKRI NIK HASSAN SUHAIMI
Student number:
109122494
Email address:
109122494@umail.ucc.ie
1931 words (Excluding Cover, Abstract, and References)

109122494 | NIK MUHAMMAD SYUKRI

2014

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

TABLE OF CONTENTS

Contents

Page

Abstract

Introduction

Methods

Search Results

Discussion

Conclusion

11

References

12

109122494 | NIK MUHAMMAD SYUKRI

2014

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

ABSTRACT
Aims and objectives:
This literature review will look at the prevalence of Gestational Diabetes(GDM)
and the type of screening program done in the health care system in different
contries.
Background:
For the past 20 years GDM prevalence has increased significantly in both
developing and developed countries, GDM will not only post threat to the
mother but the baby would also be at risk of complication such as
hypoglycemia, macrosomia, type-2 DM in future life, and respiratory distress
syndrome. Therefore, we need to pay more attention on the public health
aspects of the increasing GDM.
Methods:
Systematic library research for studies concerning the prevalence and
screening program on gestational diabetes was conducted using PubMED and
NCBI web database. Advance search tools used to sort journal published in
between 2000 and 2014 with English language restriction.
Results and conclusion:
Standards for GDM screening and management vary significantly between the
countries.
Both the universal and selective screening program has its
advantages and disadvantages. There is limited supporting evidence to
suggest one single screening program that is suitable for different populations.
An agreement on standard screening program for GDM could lead to better
detection and treatment, improved outcomes for both mother and child. With
GDM prevalence rates increasing in the countries studied there is an urgent
need to establish a pragmatic screening program and diagnostic criteria for
GDM, which are practicable, realistic and offer options that can be used in
different settings at the point of care.

109122494 | NIK MUHAMMAD SYUKRI

2014

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

INTRODUCTION
Gestational diabetes mellitus (GDM) is the condition first diagnosed during
pregnancy when the mother develops certain level of glucose intolerant(1).
GDM may posse thret both to the mother and baby. GDM may increase the
mothers risk of future diabetes, high blood pressure and pre-eclampsia.
Furthermore, a mother with a history of GDM would also be more likely to
developed GDM in future pragnancies. GDM would also affect the baby, baby
may be at higher risk of macrosomia(which could lead to birth complication
such as shoulder dystocia), pre-term birth, respiratory syndrome, hypoglycemia
and type-2 diabetes in later life.
Healthcare provide all over the world have been struggling to figure out wether
GDM screening should be offered routinely for pregnant women and if so, what
is the best screening program. To date, there is lack of consensus regarding the
best GDM screening program. An ideal screening program should identify
subjects at high risk of adverse pregnancy outcomes who would benefit most
from costly management while avoiding the low risk from the burden of
excessive interventions (2).
This literature review would look at the prevalence of GDM in different
countries and see the types of screening program done. It will also discuss the
advantages and disadvantages of the different types of screening program.
Hopefully an agreement on standard screening program for GDM could lead to
better detection and treatment, improved outcomes for both mother and child.
With GDM prevalence rates increasing around the world there is an urgent
need to establish a pragmatic screening program and diagnostic criteria for
GDM which are practicable, realistic and offer options that can be used in
different settings at the point of care(3). Furthermore, with uniform and cost
effective screening program it will improve management treatment of women
with GDM. Thus, improving the obstetrical overall outcomes.

109122494 | NIK MUHAMMAD SYUKRI

2014

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

METHODS
Literature Search strategy
Systematic library research for studies concerning effect on exercise on gestational diabetes was
conducted using Pub MED web database. Advance search tools used to sort journal published in
since 2000 until 2014 . For journal concerning general scientific information of gestational diabetes
and its statistical data, keywords used are gestational diabetes, Ireland, Europe. For journal with
regards to GDM prevalence keywords used are prevalence and gestational diabetes
Database/ Source
Pub MED

Results
3573

Table 1: Different type of web based data-sources and number of paper

came out as search results

Initially the total search results were 3573. Matching keywords were crosschecked for search result
and selection of journal were made for most relevant journal or journal which relates to topic of
interest. Detailed reviews of selected journal were made for inclusion or exclusion.

109122494 | NIK MUHAMMAD SYUKRI

2014

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

Study Selection
Inclusion criteria:

Journals regarding prevalence and GDM which the full text is available.

Only Journal which is available in English were selected.

Journals that studies GDM Screening program.

Exclusion criteria:

Non English journals.

Duplicates.

Free Full text not available

Total citation identified

from initial search (n=

Journals excluded after

removing duplicates and
irrelevance based on
titles and abstracts
Potential citations reviewed for
detailed evaluation (n=80)
All from electronic sources

Excluded studies (n=70)

Reasons for exclusion non English

journal, duplicates, Full text not
available.
Studies included in the
review (n=10)
Figure 1: Flow for article selection based on inclusion and exclusion criteria

109122494 | NIK MUHAMMAD SYUKRI

2014

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

SEARCH RESULTS
Referenc
e

First
Author

Setting
(Place and
Time)

Type of Study

(4)

Benhalim
a K et al.

Northern
Belgium
2013

Retrospective
Cohort Study.

(5)

Cosson E
et al.

Eastern
Suburb Paris
France
2002-2010

Cohort Study.

20630

(6)

Hannah
FW et al.

UK
2008

Questionnaire

(7)

JimenezMoleon JJ
et al.

San Cecilio
University
Hospital of
Granada
(SCUH) ,
Spain.
2002

Retrospective
cohort study.

2574

(8)

Lindqvist
M et al.

Sweden
2011-2012

Cross sectional
study

(9)

Murgia C
et al.

Sardinia,
Italy.
2006

Cohort Study

1,103

(10)

Pedersen
et al.

GreenLand
2008

Retrospective
Cohort study

233

Sample
Size

6727

184,18
3

Method
Two
Step
or
One
Step
Test
the
onestep
IADPS
G
screen
ing
strate
gy.
One
step
WHO
Criteri
a

Prevalence

Conclusion

Universal

5.68%

Using the IADPSG

criteria, more women are
identified as having
GDM, and these women
carry an increased risk
for adverse gestational
outcome compared to
women without GDM.

Universal

14.4%

The presence of risk

factors increased during
the last decade. This
condition is predictive of
GDM. However, a
selective screening
would lead to missing
one-third of the women
with GDM who, even
without risk factors, had
more events than
women without GDM.
Standards for GDM
screening and
management vary
significantly across the
UK.
Selective screening
might be beneficial.
Nevertheless, selective
gestational diabetes
mellitus screening under
ADA criteria seems to
entail the same
disadvantages as the
selective screening
strategies without any
apparent benefits.

Universal/
Selective
Screening

universal
(52%)
selective
(48%)

1.5%

Two
Step
Nation
al
Diabet
es
Data
Group
Criteri
a
4
Differ
ent
Types
of Two
Step
Test
Two
Step

Selective
screening.
ADA
guideline
and ACOG
guideline.

2.5%

88.7%
(selective)
11.3%
(universal)

2.9%
(selective)
2.2%
(universal)

Selective
Screening
according
to the ADA
guideline

22.3%

Selective
Screening
Program

4.3%

There was no consensus

regarding screening
regimes for GDM from
2011 through 2012 when
four different regimes
were applied in Sweden.
The difference
in prevalence of GDM
between our group
and others, particularly
other Italian regions,
is only partially
explainable by our
extended screening
procedure.
Despite a suboptimal
screening rate, the
prevalence of GDM

109122494 | NIK MUHAMMAD SYUKRI

2014

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

(11)

Sella t et
al.

Israel
2000-2010

Cohort Study

367,24
7

(12)

OSulliva
n et al.

Irish Atlantic
Seaboard

Cohort Study

(13)

Orechhio
A et al.

Switzerland

Cohort Study

1042

4.3%

the
onestep
IADPS
G
screen
ing
strate
gy.

Universal

12.4%

2 Step
Scree
ning
Progra
m

among Greenlanders
seems to be relatively
low and Greenlanders
may thus be less prone
to develop GDM.
The increasing risk of
GDM in Israel can be
explained by both rising
prevalence of women
with established risk
factors, as well as
shifting screening
practices.
With rising obesity levels
and older age of
mothers, both risk
factors for GDM, these
results would support a
national universal
screening programme.

4.8%

Incidence of GDM and

GGI as well as birth
complications resulted
significant in our country.

Table 2: Papers reviewed in this literature.

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2014

Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

DISCUSSIONS
This literature review looks at the different types of Screening program and
prevalance of Gestational Diabetes(GDM) in different countries.
All relevant study; found on the web search are listed in Table 2. From all 10
journals selected, 8 of it were Cohort studies, 1 cross-sectional studies and 1
questionnaire based study. Retrospective studies involved could mean a
drawback of underreporting due to poor documentation.
Section 1: Prevelance of GDM.
Prevalence of GDM is known to vary widely between populations, it depends on
the socio-economic status, region of the country and dietary patterns(14). In
this review, the prevalence of GDM varies between countries varying from 1.5%
to 22.3%, with the mean of 7.0%,the lowest prevalence stated in a study done
in the UK(6) and highest in a study done in Sardinia, Italy(9). The high
prevelence of GDM in Sardinia Itlay is mostly due to extended screening
procedure(9). The increasing prevalence of most countries is associated with
increasing prevalence of its risk factors such as obesity, low levels of physical
activity and changes in dietary habits(4, 5, 7, 9, 11-13). For a pragmatic
planning and management as well as the preventive strategies, the data of
prevalence of GDM and the prevalence of its risk factors are very important.

Section 2: GDM Screening.

An ideal screening program should identify subjects at high risk of adverse
pregnancy outcomes who would benefit most from costly management while
avoiding the low risk from the burden of excessive interventions. (2)
One Step v.s. Two Step.
Most journals (7-11, 13) in this review adopts the usual two step screening
program, as advise by most organization such as the American College of
Obstetricians and Gynecologists (15) and National Institute of Health(16).
Two journal studies the one-step the screening program that adopts the recent
recommendations of the International Association of Diabetes and Pregnancy
Study Group (IADPSG). In (4) only one-fourth of centers have implemented the
one-step IADPSG screening strategy. Where in one study, it concluded that the
IADPSG screening method is cost-effective. The model is most sensitive to the
likelihood of preventing future diabetes in patients identified with GDM using
post-delivery counseling and intervention(17). However, the IADPSG screening
strategy remains controversial, studies shows a high inconsistency of adverse
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Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

2014

effect of pregnancy outcomes and cost-effectiveness analyses show conflicting

results (18).

Universal v.s. Selective.

Universal screening for gestational diabetes remains controversial. In the UK
52% of healthcare centers adopts the universal screening program(6).
Universal screening that is recommended by many healthcare organizations
will lead to high false positive, labeling a large number of having GDM, without
differentiating between those at low and those at high risk of pregnancy
complications. (15) Internationally recommended method of universal
screening for GDM should be consider wisely, which minimizes the cost for the
healthcare system and individual cost, yet provides diagnostic efficacy.(19)
Both the National Institute for Health and Clinical Excellence the American
Diabetes Association (20) and
the International Diabetes Federation
recommend selective screening for gestational diabetes. In Europe, a selective
GDM screening is still the most common approach (8, 21, 22), except for the
UK(6). In one study done in Spain, suggest that selective screening might be
beneficial where GDM was found to be approximately six times lower among
low-risk gravidae than among the high-risk subjects.(7) However in one data
stand against the present selective screening, where a selective screening
would lead to missing one-third of the women with GDM who, even without risk
factors, had more events than women without GDM.(5) Furthermore, one of the
limitation of selective screening is that it is more complex than universal
screening and its implementation adds an additional burden to the health care
provider.
The sensible way in applying the selective screening program would mostly
relies on the prevalence of risk factors in the screened population. For example,
if the screened population is largely of women with no risk factor, then many
women would be spared from screening. On the contrary, in a population
mostly of overweight with additional risk factors applying selective screening
program will likely lead to the majority of women being screened. For example
in India with a high prevalence of diabetes universal screening, instead of
selective screening, for GDM is ideal.(23) Even when a test is capable of
detecting GDM accurately, in a low prevalence population the benefits of
identifying and treating cases can be outweighed by the costs of doing so. (24)

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Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

2014

CONCLUSION
Standards for GDM screening and management vary significantly
countries. Both the universal and selective screening program
advantages and disadvantages. There is limited supporting
suggest one single screening program that is suitable for
populations.

between the
has its own
evidence to
all different

An agreement on standard screening program for GDM could lead to better

detection and treatment, improved outcomes for both mother and child. With
GDM prevalence rates increasing in the countries studied there is an urgent
need to establish a pragmatic screening program and diagnostic criteria for
GDM, which are practicable, realistic and offer options that can be used in
different settings at the point of care(3).

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Prevalence of GDM and its Screening Program in Different Countries: A Review of The literature.

2014

Reference List
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Hedderson MM, Williams MA, Holt VL, Weiss NS, Ferrara A. Body mass index and weight
gain prior to pregnancy and risk of gestational diabetes mellitus. American journal of obstetrics and
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2.
Berger H, Sermer M. Counterpoint: Selective screening for gestational diabetes mellitus.
Diabetes care. 2009;32(7):1352-4.
3.
Nielsen KK, de Courten M, Kapur A. The urgent need for universally applicable simple
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Benhalima K, Hanssens M, Devlieger R, Verhaeghe J, Mathieu C. Analysis of Pregnancy
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Cosson E, Benbara A, Pharisien I, Nguyen MT, Revaux A, Lormeau B, et al. Diagnostic and
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Jimenez-Moleon JJ, Bueno-Cavanillas A, Luna-Del-Castillo JD, Garcia-Martin M, LardelliClaret P, Galvez-Vargas R. Prevalence of gestational diabetes mellitus: variations related to
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Lindqvist M, Persson M, Lindkvist M, Mogren I. No consensus on gestational diabetes
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Murgia C, Berria R, Minerba L, Malloci B, Daniele C, Zedda P, et al. Gestational diabetes
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Pedersen ML, Jacobsen JL, Jorgensen ME. Prevalence of gestational diabetes mellitus
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Sella T, Shalev V, Elchalal U, Chovel-Sella A, Chodick G. Screening for gestational diabetes
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O'Sullivan EP, Avalos G, O'Reilly M, Dennedy MC, Gaffney G, Dunne F, et al. Atlantic
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Orecchio A, Periard D, Kashef A, Magnin JL, Hayoz D, Fontana E. Incidence of gestational
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Rajput M, Bairwa M, Rajput R. Prevalence of gestational diabetes mellitus in rural Haryana:
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Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September
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Vandorsten JP, Dodson WC, Espeland MA, Grobman WA, Guise JM, Mercer BM, et al. NIH
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Meltzer SJ, Snyder J, Penrod JR, Nudi M, Morin L. Gestational diabetes mellitus screening
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