American Journal of Epidemiology Vol. 152, No. 11 : 1009-1014
Copyright © 2000 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Impact of Prenatal Glucose Screening on the Diagnosis of Gestational Diabetes and on Pregnancy Outcomes
1 Bureau of Reproductive and Child Health, Health Canada, Ottawa, Ontario, Canada.
2 Department of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
3 Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
4 Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
5 Department of Family Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
6 Epidemiology Research Group, Laval University, Quebec City, Quebec, Canada.
7 Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
The authors examined the impact of universal screening on the diagnosis of gestational diabetes and its complications. All mothers and newborns registered by the Canadian Institute for Health Information from 1984 to 1996 (even-numbered fiscal years only) were included in the analysis. Over this time period, the proportion of women with gestational diabetes increased ninefold (from 0.3% to 2.7%) while the proportion with prepregnancy diabetes fell from 0.7% to 0.4%. As rates of gestational diabetes increased, a corresponding reduction in the risks of complications (polyhydramnios, amniotic cavity infection, cesarean delivery, and preeclampsia) occurred for women with gestational diabetes. The incidence of gestational diabetes fell in Metro-Hamilton (where screening was discontinued in 1989) but remained high in the rest of Ontario (where screening continued in most areas). No related temporal trends for fetal macrosomia, cesarean delivery, or other diabetes-related complications were observed, regardless of screening policy. The authors concluded that the substantial increase in gestational diabetes in Canada is an artifact caused by universal screening, with no evidence of beneficial effects on pregnancy outcomes.
cesarean section; delivery; diabetes; gestational; fetal macrosomia; pregnancy
Abbreviations: CCP, Canadian Classification of Diagnostic, Therapeutic, and Surgical Procedures; CIHI, Canadian Institute for Health Information; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification.
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