1401-P: Universal vs. Selective Screening for Hyperglycemia First Diagnosed during Pregnancy, Including Early Hyperglycemia: Diagnostic and Prognostic Value in 4,518 Women

The aim of the study was to evaluate the prevalence of hyperglycemia first diagnosed during pregnancy (Hgly), including gestational diabetes mellitus appearing early (eGDM) or after 22 weeks of gestation (GDM) or diabetes in pregnancy (DIP) and their prognosis whether women had risk factors (RFs) for Hgly or not. We included the women without known diabetes who had in our department (2012-2016) a universal screening (first: FPG measurement in early pregnancy, with immediate care without any further screening in women with eGDM or early DIP; second: OGTT after 22 WG in the other women). We considered 4 mutually exclusive groups of women according to the presence of Hgly and of RFs according to our national guidelines (maternal age ≥ 35 years or pregravid overweight or family history of diabetes or personal history of Hgly or of macrosomic infant). We considered a predefined composite endpoint (preeclampsia or large for gestational age infant or shoulder dystocia). We included 4518 women, of whom 23.5% had Hgly (eGDM 10.4%, GDM 12.2% and DIP 0.9%) and 71.1% had ≥1 RF. The four groups were: Hgly-RF- (n=1144), Hgly-RF + (n=2313), Hgly+RF - (n=163), Hgly+RF+ (n=898). Hgly was more frequent in those with RFs (OR 2.7 [95% CI 2.3-3.3]). The incidence of the composite criterion differed (p<0.0001) across groups: Hgly-RF- 6.3%; Hgly+RF- 8.6%; Hgly-RF + 13.2%; Hgly+RF+ 17.1% (Hgly effect p<0.05, RFs effect <0.001, interaction Hgly.RF p=0.94) and increased with the number of RFs (no RF: 6.3%/1: 10.8%/2: 14.7%/3: 28.0% and 4-5: 25.0%; p<0.0001). Our observational study shows that a selective screening during pregnancy leads to misdiagnose 15.3% of HGly and that the women with treated Hgly but no RF have however a very good prognosis. On the contrary, women with RFs have a poor prognosis whatever their glycemic status, suggesting that early management for women with overweight -the only modifiable RF here- might be useful to improve outcomes.