Risk scores for selective screening for gestational diabetes in Sub Saharan Africa
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Nova Science Publishers
Abstract
Gestational diabetes mellitus (GDM) is a threat to maternal and child health. Timely
detection and proper management of GDM may reduce the risk for adverse pregnancy
outcomes and improve wellbeing of the mother and the child. Prevalence of gestational
diabetes mellitus is increasing worldwide with the highest increase noted in middle- and
low-income countries. These countries also suffer from limited resources to properly
diagnose and manage gestational diabetes mellitus and other pregnancy complications.
This chapter reviews the existing selective screening methods and their application in Sub
Saharan Africa (SSA). The current guideline recommends universal screening for all
pregnant women at any time during pregnancy to ensure that affected women have the
opportunity of receiving proper management to prevent adverse outcomes. However, in the
countries with limited human, infrastructure and financial resources, this may be a
challenge. The use of selective screening reduces the number of unnecessary oral glucose
tolerance test hence maximize the use of available resources. Nevertheless, the use of
selective screening may still have challenges due to lack of uniformity and variations on
results from application of the risk scores. The methods used to identify risk factors vary
across the countries depending on the research design, selection of participants, gestational
age at screening and diagnosis criteria used. Some risk score models did not perform well
because of the challenges in proper identification of risk factors; for example, body mass
index (BMI) is known to be one of the important predictors of GDM. However, some
studies use pre-gestational BMI by maternal recall of body weight before conception while
others used BMI at first clinic visit regardless of gestational age. Furthermore, there are
variations in gestational age at screening and diagnosis method used. There is a need to
develop country specific checklist for the risk factors which is simple, clear and easy to use
at the clinic and for self-identification to enhance self-care.
Description
Book chapter
Keywords
Gestational diabetes mellitus, Screening, Risk score, Sub-Saharan Africa