PRACTICAL SCREENING FOR DIABETES MELLITUS IN PREGNANT WOMEN

Abstract

ABSTRACT A prospective and consecutive investigation of 1697 pregnant women without earlier known diabetes and a retrospective investigation of 120 pregnant diabetics (White class A: 94, White class B: 26), has been performed. It was found that: the most useful criteria of potential diabetics were: 1) the presence of diabetes in close relatives, diagnosed before the age of 40 years, 2) the presence of obesity in the patients, defined as 20 per cent overweight or more just before pregnancy, 3) previous delivery of a big baby, defined as a baby with birthweight ≦ 4500 g. Of the 1697 pregnant women 8 per cent were potential diabetics and in 8 per cent glucosuria was found. pregnant women with glucosuria and potential diabetics defined as above had a higher risk of having a diabetic OGTT than other pregnant women. A diabetic OGTT was found with falling incidence in the groups: potential diabetics with glucosuria: 10.5 per cent, non-potential diabetics with glucosuria: 3.7 per cent, potential diabetics without glucosuria: 3.4 per cent, and in the control group (non-potential diabetics without glucosuria): 0.3 per cent. A positive correlation was found between the level of fasting plasma glucose (FPG) early in pregnancy, and the result of OGTT later in pregnancy. When FPG exceeded 89 mg/100 ml (75 mg/100 ml whole blood) the incidence of diabetic curves increased significantly. By combining the following criteria: potential diabetics – glucosuria – fasting plasma glucose, FPG, it was found that the percentage of pregnant women, which ought to be investigated with an OGTT, could be reduced to 4 per cent, while the sensitivity and the specificity of the screening was 78 per cent and 89 per cent, respectively. This approach also resulted in the detection of all the most treatmentrequiring cases of diabetes. The practical use of the screening method is described.