Universal and Selective Screening for Detection of Hyperglycaemia in Pregnancy in Low Income Country: An Appraisal of Figo Recommendation on Universal Screening.

Abstract

BACKGROUND: Hyperglycemia in pregnancy (HIP) comes with both maternal and fetal complications; universal and selective screening have been used by various guidelines for its diagnosis. An appraisal of FIGO's recommended universal screening is essential for domestication in low-resource settings. OBJECTIVE: To compare universal and selective screening methods for the determination of hyperglycemia in pregnancy (HIP), including gestational diabetes mellitus (GDM) and diabetes in pregnancy (DIP) in a low-resource setting. METHODS: A cross-sectional study of pregnant women in Enugu, southeast Nigeria. The eligible women in each group were consecutively recruited between 24-28 weeks gestational age and their fasting blood sugar (FBS) and 2 hours post prandial (2HPP) glucose levels were tested. Included were all consenting pregnant women between 24-28 weeks gestational age while excluded were those beyond 28 weeks and know diabetics already on treatment. The first group (universal group) was universally screened while in the second group (selective group) only participants with risk factors for HIP were screened. All data were analysed using statistical package for social sciences version 24 at 95% confidence level. RESULTS: The overall prevalence of HIP, GDM and DIP were 7.1% (36/508), 5.6% (28/508) and 1.4% (7/508), respectively. There was no significant difference in the prevalence of HIP, GDM and DIP between the two groups (P > 0.05). However, 42.9% of cases of GDM and 66.7% of cases of DIP recorded in the universal group were from participants without any risk factor for HIP. CONCLUSION: The detection of HIP, GDM and DIP is similar using the two screening methods. However, about half of the cases of HIP would be missed with selective screening. Obstetricians are therefore encouraged to adopt the universal screening method as selective screening is associated with missed diagnosis of HIP.