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Open Access 01-12-2021 | Gestational Diabetes | Research article

Implementation of a first-trimester prognostic model to improve screening for gestational diabetes mellitus

Authors: Fieke van Hoorn, Maria P. H. Koster, Anneke Kwee, Floris Groenendaal, Arie Franx, Mireille N. Bekker, On behalf of the RESPECT 2 study group

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

Improvement in the accuracy of identifying women who are at risk to develop gestational diabetes mellitus (GDM) is warranted, since timely diagnosis and treatment improves the outcomes of this common pregnancy disorder. Although prognostic models for GDM are externally validated and outperform current risk factor based selective approaches, there is little known about the impact of such models in day-to-day obstetric care.

Methods

A prognostic model was implemented as a directive clinical prediction rule, classifying women as low- or high-risk for GDM, with subsequent distinctive care pathways including selective midpregnancy testing for GDM in high-risk women in a prospective multicenter birth cohort comprising 1073 pregnant women without pre-existing diabetes and 60 obstetric healthcare professionals included in nine independent midwifery practices and three hospitals in the Netherlands (effectiveness-implementation hybrid type 2 study). Model performance (c-statistic) and implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability) were evaluated after 6 months by indicators and implementation instruments (NoMAD; MIDI).

Results

The adherence to the prognostic model (c-statistic 0.85 (95%CI 0.81–0.90)) was 95% (n = 1021). Healthcare professionals scored 3.7 (IQR 3.3–4.0) on implementation instruments on a 5-point Likert scale. Important facilitators were knowledge, willingness and confidence to use the model, client cooperation and opportunities for reconfiguration. Identified barriers mostly related to operational and organizational issues. Regardless of risk-status, pregnant women appreciated first-trimester information on GDM risk-status and lifestyle advice to achieve risk reduction, respectively 89% (n = 556) and 90% (n = 564)).

Conclusions

The prognostic model was successfully implemented and well received by healthcare professionals and pregnant women. Prognostic models should be recommended for adoption in guidelines.

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Title: Implementation of a first-trimester prognostic model to improve screening for gestational diabetes mellitus
Authors: Fieke van Hoorn
Maria P. H. Koster
Anneke Kwee
Floris Groenendaal
Arie Franx
Mireille N. Bekker
On behalf of the RESPECT 2 study group
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Gestational Diabetes
Gestational Diabetes
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-03749-x

2024 ASCO Annual Meeting

Springer Medicine

Implementation of a first-trimester prognostic model to improve screening for gestational diabetes mellitus

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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