Gestational diabetes: Universal or selective screening?

Objective: To evaluate the incidence of gestational diabetes in our population and verify costs of universal screening. To assess neonatal and obstetrical outcomes with respect to maternal epidemiological characteristics. Methods: Eight hundred and fifty-six pregnant women between 24th and 28th weeks of gestation were examined in this observational study. Universal screening with glucose challenge test was used to screen the group for gestational diabetes. History, obstetrical and neonatal outcomes were collected and then analyzed. Results: Gestational diabetes was diagnosed in 6.6% of cases. Patients with at least one risk factor had a cesarean section in 50% of cases and a spontaneous vaginal delivery in 23.59% of cases (p <0.001). The absence of any risk factor was found in 73.7% of positive glucose tolerance test and in 62.5% of affected patients. The cost of universal screening in our study, was 57,60 € per case identified. Conclusions: Given the high prevalence of diabetes, the high proportion of patients potentially not identified with a selective screening in this study and the relatively low cost, universal screening for gestational diabetes seems the best way to identify patients and prevent adverse obstetrical and neonatal outcomes.