A composite risk assessment model to screen for gestational diabetes mellitus among Mediterranean women

Objective: To determine whether clinical risk assessment for gestational diabetes mellitus (GDM) may preclude the need for universal screening with an oral glucose tolerance test (OGTT) in situations of economic restraint Methods: Women with either GDM (n=119) or normal glucose tolerance (n=1249) were recruited from centers among 11 Mediterranean countries between August 1, 2010, and May 31, 2011. Outcome measures included anthropomorphic and biological data, obstetric outcomes, and infant outcomes. Results: Significant risk factors for GDM included maternal age of 30 years or more; elevated body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters); elevated diastolic blood pressure; previous history of macrosomia; and family history of diabetes mellitus. These factors each had high specificity but low sensitivity for predicting GDM; however, when used in combination, sensitivity increased but specificity fell. Fasting blood glucose (FBG) level had high sensitivity (73.9%) and specificity (902%) for predicting GDM. Sensitivity was further increased by combining FBG measurement with maternal age and BMI (96.6%). Conclusion: Use of a composite model to prescreen women for GDM risk may reduce the need for universal screening with the OGTT among centers facing health-cost pressures. (C) 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.