A simplified diagnostic work-up for the detection of gestational diabetes mellitus in low resources settings: achievemen
- PDF / 922,994 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 19 Downloads / 143 Views
MATERNAL-FETAL MEDICINE
A simplified diagnostic work‑up for the detection of gestational diabetes mellitus in low resources settings: achievements and challenges Giovanni Putoto1 · Edgardo Somigliana2,3 · Federico Olivo4 · Simona Ponte4 · Michael Momoh Koroma5 · Federica Citterio4 · Michele Orsi1,2,4 · Enzo Pisani1,4 · Marica Pilon1 · Fabio Manenti1 · Giulia Segafredo1 Received: 23 January 2020 / Accepted: 25 July 2020 © The Author(s) 2020
Abstract 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. Keywords Gestational diabetes mellitus · Screening · Low-resource setting · Glucose
Introduction
* Edgardo Somigliana [email protected] 1
Doctors with Africa CUAMM, Padua, Italy
2
Università degli Studi di Milano, Via M. Fanti, 6, 20122 Milan, Italy
3
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
4
Doctors with Africa CUAMM, Freetown, Sierra Leone
5
Princess Christian Maternity Hospital, Freetown, Sierra Leone
There has been a remarkable progress in health status in low-resource countries over the past two decades. However, additional important efforts are required to improve health and reduce mortality, particularly maternal and newborn mortality [1]. Gestational Diabetes Mellitus (GDM) in low-resource settings is neglected and has been poorly s
Data Loading...
