A simplified diagnostic work-up for the detection of gestational diabetes mellitus in low resources settings: achievements and challenges.

Autor: Putoto G; Doctors with Africa CUAMM, Padua, Italy., Somigliana E; Università degli Studi di Milano, Via M. Fanti, 6, 20122, Milan, Italy. dadosomigliana@yahoo.it.; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. dadosomigliana@yahoo.it., Olivo F; Doctors with Africa CUAMM, Freetown, Sierra Leone., Ponte S; Doctors with Africa CUAMM, Freetown, Sierra Leone., Koroma MM; Princess Christian Maternity Hospital, Freetown, Sierra Leone., Citterio F; Doctors with Africa CUAMM, Freetown, Sierra Leone., Orsi M; Doctors with Africa CUAMM, Padua, Italy.; Università degli Studi di Milano, Via M. Fanti, 6, 20122, Milan, Italy.; Doctors with Africa CUAMM, Freetown, Sierra Leone., Pisani E; Doctors with Africa CUAMM, Padua, Italy.; Doctors with Africa CUAMM, Freetown, Sierra Leone., Pilon M; Doctors with Africa CUAMM, Padua, Italy., Manenti F; Doctors with Africa CUAMM, Padua, Italy., Segafredo G; Doctors with Africa CUAMM, Padua, Italy.
Jazyk: angličtina
Zdroj: Archives of gynecology and obstetrics [Arch Gynecol Obstet] 2020 Nov; Vol. 302 (5), pp. 1127-1134. Date of Electronic Publication: 2020 Jul 30.
DOI: 10.1007/s00404-020-05708-x
Abstrakt: Purpose: Modern strategies for the screening and diagnosis of Gestational Diabetes Mellitus (GDM) rely on universal Oral Glucose Tolerance Test (OGTT). However, they are unsustainable in low-income countries. In this study, we aimed at assessing the feasibility of a simplified diagnostic policy.
Methods: The study took place in an urban referral hospital in Freetown, Sierra Leone. During an 11-month period, pregnant women were offered capillary blood test for glucose assessment. They could be screened at any time during pregnancy. GDM was diagnosed if fasting glucose was ≥ 92 mg/dl or if the OGTT was positive. The latter was prescribed only to women presenting after 24 weeks' gestation with at least one risk factor for GDM and fasting capillary glucose between 85 and 91 mg/dl. A definitive diagnosis required confirmation to this aim, women with values above the thresholds were invited to refer the next working day for repeating the test after fasting overnight.
Results: Overall, 7827 women were referred for screening, of whom 6872 (87%) underwent at least one capillary glucose assessment. However, 895 of those who had a positive test did not return for confirmation. Overall, a definite assessment could be done in 5799 subjects corresponding to 76% (95% CI 75-77%) of those eligible. GDM was diagnosed in 128 women (1.9%, 95% CI 1.6-2.2%). Based on an expected confirmation rate of 22% (calculated from those who referred for confirmation) in the 895 women who did not come back, one could infer that GDM would have been diagnosed in additional 197 women, raising the prevalence to 4.7% (95% CI 4.2-5.3%).
Conclusion: Three quarters of subjects could be assessed with our approach. Data also suggest that GDM is not rare even if identification of affected cases remains challenging.
Databáze: MEDLINE
Externí odkaz: