Maternal choices and preferences for screening strategies of gestational diabetes mellitus: A exploratory study using discrete choice experiment

AIMS: This study aimed to investigate maternal preferences for gestational diabetes mellitus (GDM) screening options in rural China to identify an optimal GDM screening strategy. METHODS: Pregnant women at 24–28 gestational weeks were recruited from Shandong province, China. A discrete choice experiment (DCE) was conducted to elicit pregnant women's preferences for GDM screening strategy defined by five attributes: number of blood draws, out-of-pocket costs, screening waiting-time, number of hospital visits, and positive diagnosis rate. A mixed logistic model was employed to quantify maternal preferences, and to estimate the relative importance of included attributes in determining pregnant women's preferences for two routinely applied screening strategies (“one-step”: 75 g oral glucose tolerance test [OGTT] and “two-step”: 50 g glucose challenge-test plus 75 g OGTT). Preference heterogeneity was also investigated. RESULTS: N = 287 participants completed the DCE survey. All five predefined attributes were associated with pregnant women's preferences. Diagnostic rate was the most influential attribute (17.5 vs. 8.0%, OR: 2.89; 95%CI: 2.10 to 3.96). When changes of the attributes of “two-step” to “one-step” strategies, women's uptake probability from full “two-step” to “one-step” significantly increased with 71.3% (95%CI: 52.2 to 90.1%), but no significant difference with the first step of “two-step” (−31.0%, 95%CI: −70.2 to 8.1%). CONCLUSION: Chinese pregnant women preferred the “one-step” screening strategy to the full “two-step” strategy, but were indifferent between “one-step” and the first step of “two-step” strategies.