P28.04: Universal screening versus targeted screening for gestational diabetes mellitus at a large tertiary hospital in Singapore

To compare the universal screening model versus two different risk-based screening models (Modified NICE and KKH models) from 1 January 2016 to 31 January 2016. A prospective study of all pregnant women who underwent gestational diabetes mellitus (GDM) screening at KK Women's and Children's Hospital (KKH) from 1 January 2016 to 31 January 2016. The women were screened by oral glucose tolerance test. Advanced maternal age (AMA), BMI>30 kg/m2, family history of diabetes, multiple pregnancy, GDM in previous pregnancy and history of macrosomic baby weighing ≥4 kg were used for the KKH risk model. BMI>30 kg/m2, previous GDM, previous macrosomic baby weighing ≥4 kg, family history of diabetes and South Asian origin were used for the modified NICE risk model. 570 women underwent GDM screening. 412 women had completed data on risk factors and were analysed. In this cohort, 82.3% of women had at least one or more risk factors. Detection rate for universal screening was 15.0% (screening rate of 100%), KKH model was 13.3% (screening rate of 75.5%) and modified NICE model was 12.9% (screening rate of 66.5%) based on IADPSG criteria. Detection rate for universal screening was 17.5%, KKH risk model was 14.6% and modified NICE risk model was 12.9% based on WHO criteria. Based on the IADPSG criteria, BMI>30 kg/m2 (OR=2.39, 95% CI 1.30-4.37) and previous history of GDM (OR=3.85,95% CI 1.50-9.87) were significantly associated with increased risk of GDM. Using WHO criteria, AMA (OR = 2.59, 95% CI 1.47-4.55) and South Asian origin (OR= 1.94,95% CI 1.04-3.59) were significantly associated with increased risk of GDM. KKH model had fewer numbers of missed diagnoses for GDM compared to modified NICE model (IADPSG: 11.3% versus 14.5%, WHO: 16.7% versus 26.4%). Targeted screening will miss the diagnosis for 11.3 to 26.4% of women with GDM depending on the risk model and diagnostic criteria used. KKH model had a higher screening rate, lower number of missed diagnoses and higher detection for GDM compared to the modified NICE model.