UNIVERSAL SCREENING FOR GESTATIONAL DIABETES MELLITUS IN ANTENATAL MOTHERS IMPROVES ANTENATAL MANAGEMENT AND OUTCOMES – SINGLE CENTRE EXPERIENCE

  • Nicholas Lee Wen Sheng School of Medicine, University of Tasmania, Level 1, Medical Science 1, 17 Liverpool St, Hobart TAS 7000, Australia.
  • Daniel Wong Bang Lung School of Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
  • Safurah Jaafar Community Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
  • Sangeetha Division of Nutrition & Dietetics, School of Health Sciences, International Medical University, and, Centre for Translational Research, IMU Institute for Research, Development, and Innovations (IRDI), International Medical University 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
  • Tiffany Grace Wong chool of Medicine, University of Glasgow, University Avenue, Glasgow G12 8QQ, United Kingdom.
  • Salmiah Md Sharif Seremban Health Clinic, Jalan Rasah, Bukit Rasah, 70300 Seremban, Negeri Sembilan, Malaysia
Keywords: Universal screening, selective screening, gestational diabetes mellitus, antenatal mothers

Abstract

This study examined the impact of universal screening in diagnosing and managing gestational diabetes (GDM) amongst antenatal mother and associated neonatal outcomes. It is a single-centre, retrospective study on routinely collected data of antenatal women in Health Clinic Seremban over one year in 2018. All women diagnosed with GDM, who were not known sufferers of type 1 or type 2 diabetes were included in this study. Participants were stratified according to risk factors for GDM to compare the performance of a selective high-risk screening approach to that of universal screening for detecting GDM. Subjects were categorized as high-risk for GDM based on the guidelines recommended by the Malaysian Clinical Practice guidelines. It was found that through universal screening, 246 antenatal mothers were tested positive for GDM out of the 987 of these mothers without prior diabetes, giving a prevalence of 24.9%. If selective screening using traditional risk factors had been employed, 54 (22%) of the antenatal mothers diagnosed with GDM would have been missed. It was established that risk factors for GDM included advancing age, other ethnicities (patients that are not of Malay, Chinese nor Indian ethnicities), obesity, history of abortion or GDM and family history of diabetes mellitus. Neonatal outcomes of those with GDM as compared to those without were similar. This study highlights that universal screening improved GDM detection rates amongst antenatal mothers. The increased detection helped facilitate an earlier intervention which may have contributed to better antenatal management and outcomes for neonates and their mothers.

Author Biographies

Nicholas Lee Wen Sheng, School of Medicine, University of Tasmania, Level 1, Medical Science 1, 17 Liverpool St, Hobart TAS 7000, Australia.

Final year medical student

School of Medicine, University of Tasmania, Level 1, Medical Science 1, 17 Liverpool St, Hobart TAS 7000, Australia. nlws@utas.edu.au    

Daniel Wong Bang Lung, School of Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.

Final year medical student

School of Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia. daniel.wongbang@student.imu.edu.my

Sangeetha, Division of Nutrition & Dietetics, School of Health Sciences, International Medical University, and, Centre for Translational Research, IMU Institute for Research, Development, and Innovations (IRDI), International Medical University 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.

Senior lecturer

Nutrition & Dietetics, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia sangeethashyam@imu.edu.my  

Fellow

Centre for Translational Research, IMU Institute for Research, Development, and Innovation (IRDI), 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia , sangeethashyam@imu.edu.my  

Tiffany Grace Wong, chool of Medicine, University of Glasgow, University Avenue, Glasgow G12 8QQ, United Kingdom.

Final year medical student

School of Medicine, University of Glasgow, University Avenue, Glasgow G12 8QQ, United Kingdom 2506667W@student.glac.ac.uk

Salmiah Md Sharif, Seremban Health Clinic, Jalan Rasah, Bukit Rasah, 70300 Seremban, Negeri Sembilan, Malaysia

Family Medicine Specialist,

Seremban Health Clinic, Department of Health Negeri Sembilan, Jalan Rasah, Bukit Rasah, 70300 Seremban, Negeri Sembilan Malaysia drmayasharif@yahoo.com  

References

Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271–81.

Bener A, Saleh NM, Al-Hamaq A. Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: Global comparisons. Int J Womens Health. 2011;3:367–73.

Eades CE, Styles M, Leese GP, Cheyne H, Evans JMM. Progression from gestational diabetes to type 2 diabetes in one region of Scotland: An observational follow-up study. BMC Pregnancy Childbirth. 2015;3(15):11.

Metzger BE, Contreras M, Sacks DA, Watson W, Dooley SL, Foderaro M, Niznik C, Bjaloncik J, Catalano PM, Dierker L, Fox S. Hyperglycemia and adverse pregnancy outcomes. New England journal of medicine. 2008 May 8;358(19):1991-2002.

Kendrick JM. Screening and diagnosing gestational diabetes mellitus revisited: implications from HAPO. The Journal of perinatal & neonatal nursing. 2011 Jul 1;25(3):226-32.

Ministry of Health M. Management of diabetes in pregnancy [Internet]. 2017 [cited 2020 Sep 1]. p. 1–8. Available from: https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Endocrine/1b.pdf

Carr SR. Screening for gestational diabetes mellitus: A perspective in 1998. Diabetes Care. 1998;(Suppl 2):B14-8.

Lindsay RS, Mackin ST, Nelson SM. Gestational diabetes mellitus-right person, right treatment, right time? BMC Med. 2017;15(163).

Arora D, Rajin D, Sangthong S, Leelaporn W, Sangratanathongchai J. Universal screening of gestational diabetes mellitus: Prevalence and diagnostic value of clinical risk factors. J Med Assoc Thail. 2013;96(3):266–71.

Tieu J, Mcphee AJ, Crowther CA, Middleton P. Screening and subsequent management for gestational diabetes for improving maternal and infant health. Cochrane Database Syst Rev. 2014;11(2):CD007222.

Hod M, Pretty M, Mahmood T. Joint position statement on universal screening for GDM in Europe by FIGO, EBCOG and EAPM. Eur J Obstet Gynecol Reprod Biol. 2018;(228):329–30.

Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. In: International Journal of Gynecology and Obstetrics. 2015. p. S173-211.

International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes care 2010, 33;3 (676-682_. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827530/pdf/zdc676.pdf

Lapolla, A., Chilelli, N. C., & Dalfrà, M. G. (2011). New IADPSG recommendations: impact on care for gestational diabetes. Diabetes Management, 1(5), 497.

Idris N, Che Hatikah CH, Murizah MZ, Rushdan MN. Universal versus selective screening for detection of gestational diabetes mellitus in a Malaysian population. Malaysian Fam Physician. 2009;4(2–3):83–7.

Subramaniam L, Bukhary binti Ismail Bukhary Md N, Kesihatan Bangi K, Kesihatan

Malaysian Journal of Public Health Medicine 2021, Vol. 21(1): 230-238

Hulu langat Tan Siow Foon MBBs P, Klinik Kesihatan Pelabuhan Klang Mm, Kesihatan daerah Klang Zienna Zufida P, et al. Gestational diabetes mellitus: The prevalence, associated factors and foeto-maternal outcome of women attending antenatal care. Malaysian Fam Physician. 2017;12(2):9–17.

Shamsuddin K, Mahdy ZA, Rafiaah IS, Jamil MA, Rahimah MD. Risk factor screening for abnormal glucose tolerance in pregnancy. Int J Gynecol Obstet. 2001;75(1):27–32.

Badakhsh M, Daneshi F, Abavisani M, Rafiemanesh H, Bouya S, Sheyback M, et al. Prevalence of gestational diabetes mellitus in Eastern Mediterranean region: a systematic review and meta-analysis. Endocrine. 2019;65:505–14.

Natamba BK, Namara AA, Nyirenda MJ. Burden, risk factors and maternal and offspring outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa (SSA): a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019;19(450).

Nguyen CL, Pham NM, Binns CW, Van Duong D, Lee AH. Prevalence of gestational diabetes mellitus in eastern and southeastern Asia: A systematic review and meta-analysis. J Diabetes Res. 2018;6536974.

Abd Kadir, Ghani AAA, Rahman AB, Zainuddin AA, Jai AN, Chandran A. Institute for Public Health: National Health and Morbidity Survey 2015 (NHMS 2015). Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems. Kuala Lumpur: Min of Health Malaysia 2015. Acta Obstetrica et Gynaecologica Japonica. 2015. 15 p.

Chew WF, Rokiah P, Chan SP, Chee WSS, Lee LF, Chan YM. Prevalence of glucose intolerance, and associated antenatal and historical risk factors among Malaysian women with a history of gestational diabetes mellitus. Singapore Med J. 2012;53(12):814–20.

Hussein Z, Taher SW, Gilcharan Singh HK, Chee Siew Swee W. Diabetes Care in Malaysia: Problems, New Models, and Solutions. Ann Glob Heal. 2015;81(6):851–62.

Chong YS, Cai S, Lin H, Soh SE, Lee YS, Leow MKS, et al. Ethnic differences translate to inadequacy of high-risk screening for gestational diabetes mellitus in an Asian population: A cohort study. BMC Pregnancy Childbirth. 2014;14(345).

Hedderson MM, Darbinian JA, Ferrara A. Disparities in the risk of gestational diabetes by race-ethnicity and country of birth. Paediatr Perinat Epidemiol. 2010;24(5):441–8.

Li Y, Ren X, He L, Li J, Zhang S, Chen W. Maternal age and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of over 120 million participants. Diabetes Res Clin Pract. 2020;(162):108044.

Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care. 2007;30(8):2070–6.

Moosazadeh M, Banakar M, Behbahani D, Akbari M, Dabbaghmanesh MH, Mohamadkhani M, et al. Association between gestational diabetes mellitus and spontaneous abortion: A systematic review and meta-analysis. J Maz Univ Med Sci. 2017;27(155):187–19.

Ganeshan M, Soelar SA, Karalasingam SD, Bujang MA, Jeganathan R, Suharjono H. Effectiveness of selective risk based screening for Gestational Diabetes (GDM) in Malaysia: A retrospective cohort study based on the National Obstetric Registry (NOR) of Malaysia. Med J Malaysia. 2017;72(1):46–9.

Pejabat Ketua Perangkawan. Siaran Akhbar: Perangkaan Penting, Malaysia, 2014 [Internet]. Jabatan Perangkaan Malaysia. Kuala Lumpur; 2015. Available from: https://www.dosm.gov.my/v1/index.php?r=column/pdfPrev&id=STg1NEgvdFlaZldIc0JFNlRQczB6dz09

Published
2021-04-24
How to Cite
Lee Wen Sheng, N., Wong Bang Lung, D., Jaafar, S., Shyam, S., Grace Wong, T., & Md Sharif, S. (2021). UNIVERSAL SCREENING FOR GESTATIONAL DIABETES MELLITUS IN ANTENATAL MOTHERS IMPROVES ANTENATAL MANAGEMENT AND OUTCOMES – SINGLE CENTRE EXPERIENCE. Malaysian Journal of Public Health Medicine, 21(1), 230-238. https://doi.org/10.37268/mjphm/vol.21/no.1/art.798