Screening of Gestational Diabetes Mellitus in a West African Population: A Comparison of Systematic vs. Targeted Approaches

Background: Gestational diabetes mellitus (GDM) is a growing global health concern, with early detection plays a crucial role. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) has established threshold values for the diagnosis of GDM. However, the choice between targeted or systematic screening is left to each country’s discretion based on local prevalence rates. The main objective of our study was to assess the most suitable screening strategy in a West African population. Methods: We conducted a single-center, retrospective study on GDM screening among pregnant women attending prenatal care in the gynecology department of the National Hospital Center Dalal Jamm (CHNDJ) from January 1, 2023, to December 31, 2023. Inclusion criteria were patients who performed at least one prenatal consultation at CHNDJ and GDM screening using either fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT). Non-inclusion criteria were FPG ≥ 126 mg per deciliter (6.93 mmol per liter). Patients on group 1 had at least one of the following risk factors: age ≥ 35 years, BMI ≥ 25 kg per m², personal or first-degree family history of diabetes, or birth weight ≥ 4000 grams. Patients without risk factors listed above were in group 2. Results: 326 patients were included in the final analysis among them 92 realized a double screening with PFG followed by OGTT, 208 patients did only the PFG test and 26 patients the OGTT. Prevalence of GDM was 24% in group 1 and 7% in group 2 (p = 0.003). Regarding, FPG test, 37 (24.8) patients attended pathologic values in group 1 versus 13 (8.6) patients, (p = 0.003). For the OGTT test, 13 (22.4) patients were diagnosed in group 1 versus 2 (2.3) patients in group 2, (p = 0.001). The cost per positive case for PFG was 13 USD in group 1 and 37 USD in group 2. Regarding OGTT, the cost was respectively 71 USD and 488 USD. Conclusion: In a West African population, systematic screening using FPG during the first trimester, followed by targeted OGTT screening, appears to be a reasonable compromise, effectively balancing benefits and risks.