Risk factor-based screening compared to universal screening for gestational diabetes mellitus in marginalized Burman and Karen populations on the Thailand-Myanmar border: An observational cohort

Janna T Prüst; Tobias Brummaier; Mu Wah; Htay Htay Yee; Nyo Nyo Win; Mupawjay Pimanpanarak; Aung Myat Min; Mary Ellen Gilder; Nay Win Tun; Onaedo Ilozumba; Basirudeen Syed Ahamed Kabeer; Annalisa Terranegra; Francois Nosten; Sue J Lee; Rose McGready

doi:10.12688/wellcomeopenres.17743.2

Risk factor-based screening compared to universal screening for gestational diabetes mellitus in marginalized Burman and Karen populations on the Thailand-Myanmar border: An observational cohort

Wellcome Open Res. 2023 Jan 18:7:132. doi: 10.12688/wellcomeopenres.17743.2. eCollection 2022.

Authors

Janna T Prüst^{1

2}, Tobias Brummaier^{1

3

4}, Mu Wah¹, Htay Htay Yee¹, Nyo Nyo Win¹, Mupawjay Pimanpanarak¹, Aung Myat Min¹, Mary Ellen Gilder⁵, Nay Win Tun¹, Onaedo Ilozumba^{2

6}, Basirudeen Syed Ahamed Kabeer⁷, Annalisa Terranegra⁷, Francois Nosten^{1

8}, Sue J Lee^{8

9}, Rose McGready^{1

8}

Affiliations

¹ Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.
² Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081, The Netherlands.
³ Swiss Tropical and Public Health Institute, Allschwill, 4123, Switzerland.
⁴ University of Basel, Basel, 4001, Switzerland.
⁵ Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
⁶ Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
⁷ Research Department, Sidra Medicine, Doha, Qatar.
⁸ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK.
⁹ Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, 10400, Thailand.

Abstract

Background: Gestational diabetes mellitus (GDM) contributes to maternal and neonatal morbidity. As data from marginalized populations remains scarce, this study compares risk-factor-based to universal GDM screening in a low resource setting. Methods: This is a secondary analysis of data from a prospective preterm birth cohort. Pregnant women were enrolled in the first trimester and completed a 75g oral glucose tolerance test (OGTT) at 24-32 weeks' gestation. To define GDM cases, Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO trial) criteria were used. All GDM positive cases were treated. Sensitivity and specificity of risk-factor-based selection for screening (criteria: age ≥30y, obesity (Body mass index (BMI) ≥27.5kg/m ²), previous GDM, 1 ^st degree relative with diabetes, previous macrosomia (≥4kg), previous stillbirth, or symphysis-fundal height ≥90th percentile) was compared to universal screening using the OGTT as the gold standard. Adverse maternal and neonatal outcomes were compared by GDM status. Results: GDM prevalence was 13.4% (50/374) (95% CI: 10.3-17.2). Three quarters of women had at least one risk factor (n=271 women), with 37/50 OGTT positive cases correctly identified: sensitivity 74.0% (59.7-85.4) and specificity 27.8% (3.0-33.0). Burman women (self-identified) accounted for 29.1% of the cohort population, but 38.0% of GDM cases. Percentiles for birthweight (p=0.004), head circumference (p=0.002), and weight-length ratio (p=0.030) were higher in newborns of GDM positive compared with non-GDM mothers. 21.7% (75/346) of newborns in the cohort were small-for-gestational age (≤10 ^th percentile). In Burman women, overweight/obese BMI was associated with a significantly increased adjusted odds ratio 5.03 (95% CI: 1.43-17.64) for GDM compared with normal weight, whereas in Karen women, the trend in association was similar but not significant (OR 2.36; 95% CI 0.95-5.89). Conclusions: Risk-factor-based screening missed one in four GDM positive women. Considering the benefits of early detection of GDM and the limited additional cost of universal screening, a two-step screening program was implemented.

Keywords: Gestational diabetes mellitus; HAPO trial; Maternal and neonatal anthropometry; Migrants; Oral glucose tolerance test; Risk-factor-based screening; Symphysis-fundal height measurements; thin-diabetic.

Associated data

figshare/10.6084/m9.figshare.19382624

Grants and funding

This work was supported by Wellcome [220211; assigned to Nicholas Day]; and the parent cohort was funded by Sidra Medicine, a member of the Qatar Foundation for Education, Science and Community Development [project numbers SDR400089, SDR400075 and SDR400132].