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Journal of Diabetes Research
Volume 2017 (2017), Article ID 2849346, 9 pages
https://doi.org/10.1155/2017/2849346
Research Article

Selective Screening Strategies for Gestational Diabetes: A Prospective Cohort Observational Study

1Department of Obstetrics and Gynecology, University of Pretoria, Pretoria, South Africa
2Department of Internal Medicine, University of Pretoria, Pretoria, South Africa

Correspondence should be addressed to Sumaiya Adam

Received 14 June 2017; Revised 8 September 2017; Accepted 27 September 2017; Published 22 October 2017

Academic Editor: Daniela Foti

Copyright © 2017 Sumaiya Adam and Paul Rheeder. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aim. We aimed to develop a prediction model for the diagnosis of gestational diabetes and to evaluate the performance of published prediction tools on our population. Methods. We conducted a cohort study on nondiabetic women < 26 weeks gestation at a level 1 clinic in Johannesburg, South Africa. At recruitment, participants completed a questionnaire and random basal glucose and HbA1c were evaluated. A 75 g 2-hour OGTT was scheduled between 24–28 weeks gestation, as per FIGO guidelines. A score was derived using multivariate logistic regression. Published scoring systems were tested by deriving ROC curves. Results. In 554 women, RBG, BMI, and previous baby ≥ 4000 g were significant risk factors included for GDM, which were used to derive a nomogram-based score. The logistic regression model for prediction of GDM had R2 0.143, Somer’s Dxy rank correlation 0.407, and Harrell’s c-score 0.703. HbA1c did not improve predictive value of the nomogram at any threshold (e.g,. at probability > 10%, 25.6% of cases were detected without the HbA1c, and 25.8% of cases would have been detected with the HbA1c). The 9 published scoring systems performed poorly. Conclusion. We propose a nomogram-based score that can be used at first antenatal visit to identify women at high risk of GDM.