Australian guidelines for the screening and diagnosis of gestational diabetes mellitus (GDM) changed at the beginning of 2015 and included recommendations to screen women with risk factors with an oral glucose tolerance test (GTT) early in pregnancy. We aim to evaluate the obstetric and midwifery staff adherence to the early screening guidelines in an Australian tertiary maternity centre.
589 non-diabetic women, <20 weeks gestation and attending their first visit at Mercy antenatal clinic undertook a short researcher administered questionnaire. The questionnaire assessed all risk factors described in the screening guidelines. Following the appointment, researchers reviewed medical records and online pathology systems to determine if an early GTT was ordered, and whether a midwife, obstetrician or junior medical staff member provided care. Data was collected and managed using REDCap and analysed with STATA, using univariate analysis and multiple logistic regression.
59.9% (n=353) of participants were eligible for an early test. 30% (n=106) of the eligible women were appropriately offered an early GTT. 2.1% (n=5) of the low-risk women were offered an early GTT inappropriately. There was no significant difference in appropriate ordering or not ordering between categories of staff (p=0.35). Variables significantly associated with a reduced likelihood of appropriate screening included age>40 (OR 0.04, 95%CI 0.00-0.31, p=0.002), high-risk ethnicity (OR 0.10, 95%CI 0.05-0.18, p<0.001), first-degree family history (OR 0.36, 95%CI 0.18-0.69, p=0.002), and polycystic ovarian syndrome (OR 0.22, 95%CI 0.10-0.50, p<0.001). Previous GDM (OR 61.64, 95%CI 13.88-273.71, p<0.001) was associated with appropriate screening. BMI was not significant (p=0.294).
Adherence to early screening recommendations for gestational diabetes is poor. 70% of high-risk women were not given the opportunity for early diagnosis. We are not appropriately screening women with risk factors other than previous GDM. A greater understanding of the barriers and attitudes to early screening would be useful in improving guideline adherence.