Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya: a prospective comparison of point of care diagnostic methods.

Autor: Pastakia SD; Department of Pharmacy Practice, Purdue Kenya Partnership, PO Box 5760, Eldoret, 30100, Kenya. spastaki@gmail.com., Njuguna B; Department of Pharmacy, Moi Teaching and Referral Hospital, PO Box 3, Eldoret, 30100, Kenya., Onyango BA; Department of Pharmacy, Moi Teaching and Referral Hospital, PO Box 3, Eldoret, 30100, Kenya., Washington S; Department of Reproductive Medicine, University of California, San Diego, CA, 92103, USA., Christoffersen-Deb A; Department of Obstetrics & Gyneacology, University of Toronto, Toronto, ON, M5G 1E2, Canada., Kosgei WK; Division of Reproductive Health, Moi Teaching and Referral Hospital, PO Box 3, Eldoret, 30100, Kenya., Saravanan P; Department of Diabetes, Endocrinology & Metabolism, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.; Diabetes and Endocrine Centre, George Eliot Hospital, Nuneaton, CV107DJ, UK.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2017 Jul 14; Vol. 17 (1), pp. 226. Date of Electronic Publication: 2017 Jul 14.
DOI: 10.1186/s12884-017-1415-4
Abstrakt: Background: Early diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting.
Methods: Eligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference.
Results: Six hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity.
Conclusions: POC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify sensitive and specific POC GDM screening strategies using adverse pregnancy outcomes as end points are required.
Trials Registration: Clinical trials.gov : NCT02978807 , Registered 29 November 2016.
Databáze: MEDLINE
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