Aims: To compare the characteristics, pregnancy outcomes and tolerance of screening tests between women who prefer a two-step screening strategy with a glucose challenge test (GCT), women who prefer an one-step screening strategy with an oral glucose tolerance test (OGTT) and women without clear preference for screening method for gestational diabetes mellitus (GDM).
Methods: 1803 women from a Belgian multi-centric prospective cohort study (BEDIP-N study) received both a GCT and a 75g oral OGTT using the IADPSG criteria. Tolerance of screening tests and preference for screening strategy were evaluated by a self-designed questionnaire at the time of the GCT and OGTT.
Results: Of all women, 46.3% (834) preferred two-step screening, 26.2% (472) preferred an one-step screening strategy and 27.6% (497) had no clear preference. Women who preferred one-step screening had more often complaints from the GCT compared to women who preferred two-step screening [25.0% (114) vs. 18.0% (146), P = 0.003], while women who preferred two-step screening had more complaints from the OGTT compared to women who preferred the one-step strategy [50.4% (420) vs. 40.3% (190), P < 0.001] or women without preference [50.4% (420) vs. 34.9% (173), P < 0.001]. There was no difference in rate of parity between groups. Compared to women who preferred one-step screening, women who preferred two-step screening had less often an ethnic minority background [6.0% (50) vs. 10.7% (50), P = 0.003], had less often a low income [1.8% (15) vs. 5.0% (23), P = 0.003], had less often a first degree family history of GDM [3.8% (29) vs. 6.4% (28), P = 0.039] or a previous history of GDM [7.3% (29) vs. 13.8% (32), P = 0.008], had a lower BMI [23.9 ± 4.0 vs. 25.4 ± 5.3, P < 0.001), were less overweight or obese [respectively 23.1% (50) vs. 24.8% (116), P < 0.001 and 7.9% (66) vs. 18.2% (85), P < 0.001], and less insulin resistant in early pregnancy (HOMA-IR 8.9 (6.4-12.3) vs. 9.9 (7.2-14.2), P < 0.001]. Pregnancy outcomes were similar, except for a lower rate of labour inductions and emergency caesarean sections (CS) in the two-step screening group [respectively 26.6% (198) vs. 32.5% (137), P = 0.031 and 8.2% (68) vs. 13.0% (61), P = 0.005].
Conclusions: Women with a more adverse metabolic profile preferred one-step screening with OGTT while women who preferred two-step screening had a better metabolic profile, and more complaints of the OGTT.