Pastakia, Sonak D., Njuguna, Benson, Onyango, Beryl Ajwang', Washington, Sierra, Christoffersen-Deb, Astrid, Kosgei, Wycliffe K. and Saravanan, Ponnusamy (2017) Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya : a prospective comparison of point of care diagnostic methods. BMC Pregnancy and Childbirth, 17 (1). 226.

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Abstract

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.

Item Type:	Journal Article
Subjects:	R Medicine > RG Gynecology and obstetrics
Divisions:	Faculty of Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Diabetes in pregnancy -- Diagnosis, Diabetes in pregnancy -- Africa, Sub-Saharan, Medical screening -- Economic aspects, Point-of-care testing
Journal or Publication Title:	BMC Pregnancy and Childbirth
Publisher:	BioMed Central Ltd.
ISSN:	1471-2393
Official Date:	14 July 2017
Dates:	Date Event 14 July 2017 Published 5 July 2017 Accepted
Volume:	17
Number:	1
Number of Pages:	9
Article Number:	226
Status:	Peer Reviewed
Publication Status:	Published
Publisher Statement:	** From PubMed via Jisc Publications Router. ** History: ** received: 09-12-2016 ** accepted: 05-07-2017
Access rights to Published version:	Open Access
Funder:	United States. Agency for International Development (USAID), National Institutes of Health (U.S.) (NIH)
Grant number:	AID-623-A-12-0001 (USAID), UL1 TR001108 (NIH)

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