Cargando…

Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts

BACKGROUND: Easily identifiable risk factors including: obesity and ethnicity at high risk of diabetes are commonly used to indicate which women should be offered the oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM). Evidence regarding these risk factors is limited however....

Descripción completa

Detalles Bibliográficos
Autores principales: Farrar, Diane, Simmonds, Mark, Bryant, Maria, Lawlor, Debbie A., Dunne, Fidelma, Tuffnell, Derek, Sheldon, Trevor A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383279/
https://www.ncbi.nlm.nih.gov/pubmed/28384264
http://dx.doi.org/10.1371/journal.pone.0175288
_version_ 1782520255864635392
author Farrar, Diane
Simmonds, Mark
Bryant, Maria
Lawlor, Debbie A.
Dunne, Fidelma
Tuffnell, Derek
Sheldon, Trevor A.
author_facet Farrar, Diane
Simmonds, Mark
Bryant, Maria
Lawlor, Debbie A.
Dunne, Fidelma
Tuffnell, Derek
Sheldon, Trevor A.
author_sort Farrar, Diane
collection PubMed
description BACKGROUND: Easily identifiable risk factors including: obesity and ethnicity at high risk of diabetes are commonly used to indicate which women should be offered the oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM). Evidence regarding these risk factors is limited however. We conducted a systematic review (SR) and meta-analysis and individual participant data (IPD) analysis to evaluate the performance of risk factors in identifying women with GDM. METHODS: We searched MEDLINE, Medline in Process, Embase, Maternity and Infant Care and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2016 and conducted additional reference checking. We included observational, cohort, case-control and cross-sectional studies reporting the performance characteristics of risk factors used to identify women at high risk of GDM. We had access to IPD from the Born in Bradford and Atlantic Diabetes in Pregnancy cohorts, all pregnant women in the two cohorts with data on risk factors and OGTT results were included. RESULTS: Twenty nine published studies with 211,698 women for the SR and a further 14,103 women from two birth cohorts (Born in Bradford and the Atlantic Diabetes in Pregnancy study) for the IPD analysis were included. Six studies assessed the screening performance of guidelines; six examined combinations of risk factors; eight evaluated the number of risk factors and nine examined prediction models or scores. Meta-analysis using data from published studies suggests that irrespective of the method used, risk factors do not identify women with GDM well. Using IPD and combining risk factors to produce the highest sensitivities, results in low specificities (and so higher false positives). Strategies that use the risk factors of age (>25 or >30) and BMI (>25 or 30) perform as well as other strategies with additional risk factors included. CONCLUSIONS: Risk factor screening methods are poor predictors of which pregnant women will be diagnosed with GDM. A simple approach of offering an OGTT to women 25 years or older and/or with a BMI of 25kg/m(2) or more is as good as more complex risk prediction models. Research to identify more accurate (bio)markers is needed. Systematic Review Registration: PROSPERO CRD42013004608
format Online
Article
Text
id pubmed-5383279
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-53832792017-05-03 Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts Farrar, Diane Simmonds, Mark Bryant, Maria Lawlor, Debbie A. Dunne, Fidelma Tuffnell, Derek Sheldon, Trevor A. PLoS One Research Article BACKGROUND: Easily identifiable risk factors including: obesity and ethnicity at high risk of diabetes are commonly used to indicate which women should be offered the oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM). Evidence regarding these risk factors is limited however. We conducted a systematic review (SR) and meta-analysis and individual participant data (IPD) analysis to evaluate the performance of risk factors in identifying women with GDM. METHODS: We searched MEDLINE, Medline in Process, Embase, Maternity and Infant Care and the Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2016 and conducted additional reference checking. We included observational, cohort, case-control and cross-sectional studies reporting the performance characteristics of risk factors used to identify women at high risk of GDM. We had access to IPD from the Born in Bradford and Atlantic Diabetes in Pregnancy cohorts, all pregnant women in the two cohorts with data on risk factors and OGTT results were included. RESULTS: Twenty nine published studies with 211,698 women for the SR and a further 14,103 women from two birth cohorts (Born in Bradford and the Atlantic Diabetes in Pregnancy study) for the IPD analysis were included. Six studies assessed the screening performance of guidelines; six examined combinations of risk factors; eight evaluated the number of risk factors and nine examined prediction models or scores. Meta-analysis using data from published studies suggests that irrespective of the method used, risk factors do not identify women with GDM well. Using IPD and combining risk factors to produce the highest sensitivities, results in low specificities (and so higher false positives). Strategies that use the risk factors of age (>25 or >30) and BMI (>25 or 30) perform as well as other strategies with additional risk factors included. CONCLUSIONS: Risk factor screening methods are poor predictors of which pregnant women will be diagnosed with GDM. A simple approach of offering an OGTT to women 25 years or older and/or with a BMI of 25kg/m(2) or more is as good as more complex risk prediction models. Research to identify more accurate (bio)markers is needed. Systematic Review Registration: PROSPERO CRD42013004608 Public Library of Science 2017-04-06 /pmc/articles/PMC5383279/ /pubmed/28384264 http://dx.doi.org/10.1371/journal.pone.0175288 Text en © 2017 Farrar et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Farrar, Diane
Simmonds, Mark
Bryant, Maria
Lawlor, Debbie A.
Dunne, Fidelma
Tuffnell, Derek
Sheldon, Trevor A.
Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts
title Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts
title_full Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts
title_fullStr Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts
title_full_unstemmed Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts
title_short Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts
title_sort risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: a systematic review and meta-analysis and analysis of two pregnancy cohorts
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383279/
https://www.ncbi.nlm.nih.gov/pubmed/28384264
http://dx.doi.org/10.1371/journal.pone.0175288
work_keys_str_mv AT farrardiane riskfactorscreeningtoidentifywomenrequiringoralglucosetolerancetestingtodiagnosegestationaldiabetesasystematicreviewandmetaanalysisandanalysisoftwopregnancycohorts
AT simmondsmark riskfactorscreeningtoidentifywomenrequiringoralglucosetolerancetestingtodiagnosegestationaldiabetesasystematicreviewandmetaanalysisandanalysisoftwopregnancycohorts
AT bryantmaria riskfactorscreeningtoidentifywomenrequiringoralglucosetolerancetestingtodiagnosegestationaldiabetesasystematicreviewandmetaanalysisandanalysisoftwopregnancycohorts
AT lawlordebbiea riskfactorscreeningtoidentifywomenrequiringoralglucosetolerancetestingtodiagnosegestationaldiabetesasystematicreviewandmetaanalysisandanalysisoftwopregnancycohorts
AT dunnefidelma riskfactorscreeningtoidentifywomenrequiringoralglucosetolerancetestingtodiagnosegestationaldiabetesasystematicreviewandmetaanalysisandanalysisoftwopregnancycohorts
AT tuffnellderek riskfactorscreeningtoidentifywomenrequiringoralglucosetolerancetestingtodiagnosegestationaldiabetesasystematicreviewandmetaanalysisandanalysisoftwopregnancycohorts
AT sheldontrevora riskfactorscreeningtoidentifywomenrequiringoralglucosetolerancetestingtodiagnosegestationaldiabetesasystematicreviewandmetaanalysisandanalysisoftwopregnancycohorts