, Volume 63, Issue 3, pp 507–512 | Cite as

Universal vs. risk-factor-based screening for gestational diabetes—an analysis from a 5-Year Portuguese Cohort

  • Claudia Matta-CoelhoEmail author
  • Ana Margarida Monteiro
  • Vera Fernandes
  • Maria Lopes Pereira
  • Portuguese Diabetes and Pregnancy Study Group
  • Selma B. Souto
Original Article



The criteria to screen for Gestational Diabetes Mellitus are not internationally consensual. In opposition to the universal screening performed in Portugal, certain countries advocate a risk-factor-based screening. We aim to compare obstetric and neonatal outcomes in pregnant women with and without risk factors treated for Gestational Diabetes Mellitus.


Retrospective and multicentric study of 12,006 pregnant women diagnosed with Gestational Diabetes Mellitus between 2011 and 2015, in Portugal. Gestational Diabetes Mellitus was diagnosed according to the International Association of the Diabetes and Pregnancy Study Groups criteria. Risk factors: body mass index > 30kg/m2, history of Gestational Diabetes Mellitus, history of macrossomic newborn (birth weight > 4000 g) or first-degree relatives with Type 2 Diabetes Mellitus. Exclusion criteria: lack of data concerning risk factors (n = 1563).


At least one risk factor was found in 68.2% (n = 7123) pregnant women. Pregnant women with risk factors were more frequently medicated with insulin (p < 0.001), caesarean section was more commonly performed (p < 0.001), their newborns were more frequently large-for-gestational-age (p < 0.001) and neonatal morbidity was higher (p = 0.040) in comparison to pregnant women without risk factors. The Diabetes Mellitus reclassification test showed an increased frequency of intermediate hyperglycaemia and Diabetes Mellitus in women with risk factors (p < 0.001).


Almost one-third of pregnant women would have remained undiagnosed if risk-based-factor screening were implemented in Portugal. Women without risk factors presented fewer obstetric and neonatal complications. However, more than one third required insulin therapy.


Diabetes gestational Risk factors Diagnosis Mass screening 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


  1. 1.
    B. Baz, J.P. Riveline, J.F. Gautier, Gestational diabetes mellitus: definition, aetiological and clinical aspects. Eur. J. Endocrinol. 174, 43–51 (2016)CrossRefGoogle Scholar
  2. 2.
    Diabetologia S. P. Factos e números. Observatório Nacional da Diabetes. (2016). Accessed 1 Sept 2017
  3. 3.
    H. Berger, M. Sermer, Counterpoint: selective screening for gestational diabetes mellitus. Diabetes Care 32, 1352–1354 (2009)CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. WHO. (2013). Accessed 1 Sept 2017
  5. 5.
    Diabetologia SP. Consenso “Diabetes Gestacional” – Atualização 2016. Portuguese Diabetes and Pregnancy Study Group. (2016). Accessed 1 Sept 2017
  6. 6.
    National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. (2015). Accessed 1 Sept 2017
  7. 7.
    J. Tieu, A. J. McPhee, C. A. Crowther, P. Middleton, E. Shepherd, Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health. Cochrane Database Syst Rev. 8, 1–67 (2017).Google Scholar
  8. 8.
    D. Farrar, L. Fairley, J. Wright, D. Tuffnell, D. Whitelaw, D.A. Lawlor, Evaluation of the impact of universal testing for gestational diabetes mellitus on maternal and neonatal health outcomes: a retrospective analysis. BMC Pregnancy Childbirth 14, 1–8 (2014)CrossRefGoogle Scholar
  9. 9.
    D. Naylor, M. Sermer, E. Chen, D. Farine, Selective screening for gestational diabetes mellitus. N. Engl. J. Med. 337, 1591–1596 (1997)CrossRefPubMedGoogle Scholar
  10. 10.
    International Association of Diabetes and Pregnancy Study Groups Consensus Panel., International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33, 676–682 (2010)CrossRefPubMedCentralGoogle Scholar
  11. 11.
    The HAPO Study Cooperative Research Group., Hyperglycemia and adverse pregnancy outcomes. N. Engl. J. Med. 358, 1991–2002 (2008)CrossRefGoogle Scholar
  12. 12.
    G.E. Avalos, L.A. Owens, F. Dunne, Applying current screening tools for gestational diabetes mellitus to a european population: Is it time for change? Diabetes Care 36, 3040–3044 (2013)CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Adam S., Rheeder P. Screening for gestational diabetes mellitus in a South African population: prevalence, comparison of diagnostic criteria and the role of risk factors. 107, 523–527 (2017)Google Scholar
  14. 14.
    F. Galtier, Definition, epidemiology, risk factors. Diabetes Metab. 36, 628–651 (2010)CrossRefPubMedGoogle Scholar
  15. 15.
    American Diabetes Association. Standards of Medical Care in Diabetes 2017. Diabetes Care. 40, 1–135, (supplement 1), (2016)Google Scholar
  16. 16.
    T. Cundy, E. Ackermann, E.A. Ryan, Gestational diabetes: new criteria may triple the prevalence but effect on outcomes is unclear. BMJ 348, 1567 (2014)CrossRefGoogle Scholar
  17. 17.
    C.D. Naylor, M. Sermer, E. Chen, Sykora, K. Cesarean, Delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? JAMA 275, 1165–1170 (1996)CrossRefPubMedGoogle Scholar
  18. 18.
    R. Gorgal, E. Gonçalves, M. Barros, G. Namora, A. Magalhães, T. Rodrigues, N. Montenegro, Gestational diabetes mellitus: A risk factor for non-elective cesarean section. J. Obstet. Gynaecol. Res. 38, 154–159 (2012)CrossRefPubMedGoogle Scholar
  19. 19.
    C. Nilsson, D. Ursing, H. Strevens, M. Landin-Olsson, Towards normalized birthweight in gestational diabetes mellitus. Acta Obstet. Gynecol. Scand. 94, 1090–1094 (2015)CrossRefPubMedGoogle Scholar
  20. 20.
    S. Brito, A. Brett, J. Agro, Large for gestational age newborns: concept and reality. Acta Pediatr. Port. 45, 7–15 (2014)Google Scholar
  21. 21.
    T.F. Esakoff, A. Guillet, A.B. Caughey, Does small for gestational age worsen outcomes in gestational diabetics? J Matern-Fetal Neonat Med 30, 890–893 (2016)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Endocrinology DepartmentHospital de BragaBragaPortugal
  2. 2.Center for Health Technology and Services Research (CINTESIS)University of PortoPortoPortugal
  3. 3.Portuguese Society of DiabetologyPortoPortugal

Personalised recommendations