Adapted Screening Methods for Gestational Diabetes in Low‐Resource Settings—A Narrative Review of Observational Studies
- 1Department of Gynecology and Obstetrics University Hospital Basel Basel Switzerland unispital-basel.ch
- 2Swiss Tropical and Public Health Institute Allschwil Switzerland swisstph.ch
- 3University of Basel Basel Switzerland unibas.ch
Abstract
Introduction: Gestational diabetes mellitus (GDM) affects approximately 14%–17% of pregnancies worldwide, with the vast majority of cases occurring in low‐resource settings. There is an ongoing debate concerning the optimal screening and diagnosis of GDM, as the current diagnostic recommendation of performing a universal oral glucose tolerance test (OGTT) for every pregnant woman (WHO, 2013) is resource‐intensive and can potentially lead to overdiagnosis. This narrative literature reviews aimed to evaluate the diagnostic sensitivity of alternative, less resource‐demanding screening methods that could be appropriately used for low‐resource settings.
Methods: For this narrative review, observational studies were identified via PubMed. The PRISMA guidelines were used to guide this process. As the studies investigated very diverse screening methods, no statistical meta‐analysis was performed due to methodological heterogeneity; instead, the results were synthesized narratively.
Results: Ten studies were included, examining various alternatives such as fasting plasma glucose thresholds (sensitivity 95.6%), selective screening strategies (sensitivity 73.6%), capillary blood glucose testing (sensitivity 67.9%, 79.3%, and 92.5% for different fasting cut points), and glycated hemoglobin (HbA1c) measurements (sensitivity approximately 84%, depending on the cut‐offs).
Discussion: All alternatives showed inferior sensitivity compared to the standard OGTT; therefore, none can currently substitute the OGTT. However, basically all approaches have the potential to either reduce the number of OGTTs or improve access to GDM screening for more patients. Further research and validation are necessary for all approaches to safely reduce the number of OGTTs without compromising diagnostic accuracy.
Related
- Validating an early pregnancy HbA1c as the screening test for gestational diabetes mellitus: findings from PRISMA Pakistan cohort
- Decision-Supported Collaborative Care for Gestational Diabetes: A Narrative Review of Development Pathways and Evaluation in Routine Clinical Practice.
- A qualitative evaluation of provider decision-making and patient experiences with 1-step and 2-step gestational diabetes (GDM) screening
- Regional one-step and two-step gestational diabetes screening recommendations and birthweight outcomes in Belgium: A population-based controlled before-after study.
- Universal Screening with a Glucose Challenge Test to Predict Gestational Diabetes Mellitus in a Diverse Population: A Retrospective Cohort Study
BibTeX
@article{kittelmann2026adapted,
title = {{Adapted Screening Methods for Gestational Diabetes in Low‐Resource Settings—A Narrative Review of Observational Studies}},
author = {Magdalena Kittelmann and Cécile Monod and Beatrice Mosimann},
journal = {Journal of Pregnancy},
year = {2026},
month = oct,
doi = {10.1155/jp/6473503},
url = {https://doi.org/10.1155/jp/6473503},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Adapted Screening Methods for Gestational Diabetes in Low‐Resource Settings—A Narrative Review of Observational Studies
AU - Magdalena Kittelmann
AU - Cécile Monod
AU - Beatrice Mosimann
PY - 2026
DA - 2026/10/30
JO - Journal of Pregnancy
DO - 10.1155/jp/6473503
UR - https://doi.org/10.1155/jp/6473503
AB - Introduction: Gestational diabetes mellitus (GDM) affects approximately 14%–17% of pregnancies worldwide, with the vast majority of cases occurring in low‐resource settings. There is an ongoing debate concerning the optimal screening and diagnosis of GDM, as the current diagnostic recommendation of performing a universal oral glucose tolerance test (OGTT) for every pregnant woman (WHO, 2013) is resource‐intensive and can potentially lead to overdiagnosis. This narrative literature reviews aimed to evaluate the diagnostic sensitivity of alternative, less resource‐demanding screening methods that could be appropriately used for low‐resource settings. Methods: For this narrative review, observational studies were identified via PubMed. The PRISMA guidelines were used to guide this process. As the studies investigated very diverse screening methods, no statistical meta‐analysis was performed due to methodological heterogeneity; instead, the results were synthesized narratively. Results: Ten studies were included, examining various alternatives such as fasting plasma glucose thresholds (sensitivity 95.6%), selective screening strategies (sensitivity 73.6%), capillary blood glucose testing (sensitivity 67.9%, 79.3%, and 92.5% for different fasting cut points), and glycated hemoglobin (HbA1c) measurements (sensitivity approximately 84%, depending on the cut‐offs). Discussion: All alternatives showed inferior sensitivity compared to the standard OGTT; therefore, none can currently substitute the OGTT. However, basically all approaches have the potential to either reduce the number of OGTTs or improve access to GDM screening for more patients. Further research and validation are necessary for all approaches to safely reduce the number of OGTTs without compromising diagnostic accuracy.
SN - 2090-2727
SN - 2090-2735
ER -