Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome

Diabet Med. 2000 Jan;17(1):26-32. doi: 10.1046/j.1464-5491.2000.00214.x.


Aims: Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcome. Screening for GDM is therefore recommended but the best screening method remains controversial. This prospective, randomized study compared a risk factor-based screening programme with a universally based one.

Methods: Subjects were randomized at booking to one of two groups: the risk factor group had a 3-h 100-g oral glucose tolerance test (OGTT) at 32 weeks if any risk factor for GDM was present; the universal group had a 50-g glucose challenge test performed and if their plasma glucose at 1 h was > or = 7.8 mmol/l, a formal 3-h 100-g OGTT was then performed.

Results: Universal screening detected a prevalence of GDM of 2.7%, significantly more than the 1.45% detected in the risk factor screened group (P<0.03). Universal screening facilitated earlier diagnosis than risk factor screening - mean gestation 30 +/- 2.6 weeks vs. 33 +/- 3.7 weeks (P<0.05). A higher rate of spontaneous vaginal delivery at term, and lower rates of macrosomia, Caesarean section, prematurity, pre-eclampsia and admission to neonatal intensive care unit were observed in the universally screened, early diagnosis group.

Conclusions: Universal screening for GDM is superior to risk factor based screening-detecting more cases, facilitating early diagnosis and is associated with improved pregnancy outcome.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Glucose / metabolism
  • Cesarean Section / statistics & numerical data
  • Delivery, Obstetric
  • Diabetes, Gestational / diagnosis*
  • Diabetes, Gestational / epidemiology
  • Female
  • Fetal Macrosomia / epidemiology
  • Glucose Tolerance Test*
  • Humans
  • Hyperbilirubinemia / epidemiology
  • Hypoglycemia / epidemiology
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Ireland / epidemiology
  • Mass Screening / methods*
  • Pre-Eclampsia / epidemiology
  • Pregnancy
  • Pregnancy Outcome
  • Prevalence
  • Prospective Studies
  • Risk Factors


  • Blood Glucose