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Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts

View Article: PubMed Central - PubMed

ABSTRACT

Background: Easily identifiable risk factors including: obesity and ethnicity at high risk of diabetes are commonly used to indicate which women should be offered the oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM). Evidence regarding these risk factors is limited however. We conducted a systematic review (SR) and meta-analysis and individual participant data (IPD) analysis to evaluate the performance of risk factors in identifying women with GDM.

Methods: We searched MEDLINE, Medline in Process, Embase, Maternity and Infant Care and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2016 and conducted additional reference checking. We included observational, cohort, case-control and cross-sectional studies reporting the performance characteristics of risk factors used to identify women at high risk of GDM. We had access to IPD from the Born in Bradford and Atlantic Diabetes in Pregnancy cohorts, all pregnant women in the two cohorts with data on risk factors and OGTT results were included.

Results: Twenty nine published studies with 211,698 women for the SR and a further 14,103 women from two birth cohorts (Born in Bradford and the Atlantic Diabetes in Pregnancy study) for the IPD analysis were included. Six studies assessed the screening performance of guidelines; six examined combinations of risk factors; eight evaluated the number of risk factors and nine examined prediction models or scores. Meta-analysis using data from published studies suggests that irrespective of the method used, risk factors do not identify women with GDM well.

Results: Using IPD and combining risk factors to produce the highest sensitivities, results in low specificities (and so higher false positives). Strategies that use the risk factors of age (>25 or >30) and BMI (>25 or 30) perform as well as other strategies with additional risk factors included.

Conclusions: Risk factor screening methods are poor predictors of which pregnant women will be diagnosed with GDM. A simple approach of offering an OGTT to women 25 years or older and/or with a BMI of 25kg/m2 or more is as good as more complex risk prediction models. Research to identify more accurate (bio)markers is needed.

Conclusions: Systematic Review Registration: PROSPERO CRD42013004608

No MeSH data available.


Flow chart of the systematic review search process.
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pone.0175288.g001: Flow chart of the systematic review search process.

Mentions: Searches identified 4272 unique citations (7858 before de-duplication). Thirteen additional publications were identified through reference checking. After title and abstract screening, 225 publications were retrieved for full-text screening. One hundred and ninety six full text papers were excluded because they did not meet eligibility criteria, leaving 29 studies (Fig 1), with 211,698 women. Six studies [33–38] assessed the screening performance of guideline recommendations (UK National Institute for Health and Care Excellence (NICE),[37] American Diabetes Association (ADA),[35–38] American College of Obstetricians and Gynecologists (ACOG),[36] Australasian Diabetes In Pregnancy Society (ADIPS),[37] Irish,[33] French[34]). Eight studies evaluated the screening performance of the number of risk factors (for example if two, three or four etc. risk factors were present),[39–46] six examined combinations of risk factors[28,47–51] and nine studies examined the ability of a risk prediction model or a risk score to predict GDM. [52–60]


Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts
Flow chart of the systematic review search process.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383279&req=5

pone.0175288.g001: Flow chart of the systematic review search process.
Mentions: Searches identified 4272 unique citations (7858 before de-duplication). Thirteen additional publications were identified through reference checking. After title and abstract screening, 225 publications were retrieved for full-text screening. One hundred and ninety six full text papers were excluded because they did not meet eligibility criteria, leaving 29 studies (Fig 1), with 211,698 women. Six studies [33–38] assessed the screening performance of guideline recommendations (UK National Institute for Health and Care Excellence (NICE),[37] American Diabetes Association (ADA),[35–38] American College of Obstetricians and Gynecologists (ACOG),[36] Australasian Diabetes In Pregnancy Society (ADIPS),[37] Irish,[33] French[34]). Eight studies evaluated the screening performance of the number of risk factors (for example if two, three or four etc. risk factors were present),[39–46] six examined combinations of risk factors[28,47–51] and nine studies examined the ability of a risk prediction model or a risk score to predict GDM. [52–60]

View Article: PubMed Central - PubMed

ABSTRACT

Background: Easily identifiable risk factors including: obesity and ethnicity at high risk of diabetes are commonly used to indicate which women should be offered the oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM). Evidence regarding these risk factors is limited however. We conducted a systematic review (SR) and meta-analysis and individual participant data (IPD) analysis to evaluate the performance of risk factors in identifying women with GDM.

Methods: We searched MEDLINE, Medline in Process, Embase, Maternity and Infant Care and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2016 and conducted additional reference checking. We included observational, cohort, case-control and cross-sectional studies reporting the performance characteristics of risk factors used to identify women at high risk of GDM. We had access to IPD from the Born in Bradford and Atlantic Diabetes in Pregnancy cohorts, all pregnant women in the two cohorts with data on risk factors and OGTT results were included.

Results: Twenty nine published studies with 211,698 women for the SR and a further 14,103 women from two birth cohorts (Born in Bradford and the Atlantic Diabetes in Pregnancy study) for the IPD analysis were included. Six studies assessed the screening performance of guidelines; six examined combinations of risk factors; eight evaluated the number of risk factors and nine examined prediction models or scores. Meta-analysis using data from published studies suggests that irrespective of the method used, risk factors do not identify women with GDM well.

Results: Using IPD and combining risk factors to produce the highest sensitivities, results in low specificities (and so higher false positives). Strategies that use the risk factors of age (>25 or >30) and BMI (>25 or 30) perform as well as other strategies with additional risk factors included.

Conclusions: Risk factor screening methods are poor predictors of which pregnant women will be diagnosed with GDM. A simple approach of offering an OGTT to women 25 years or older and/or with a BMI of 25kg/m2 or more is as good as more complex risk prediction models. Research to identify more accurate (bio)markers is needed.

Conclusions: Systematic Review Registration: PROSPERO CRD42013004608

No MeSH data available.