DIABETES MELLITUS Screening for gestational diabetes mellitus in northeastern Turkey (Trabzon city) Cihangir Erem 1 , Nihat Cihanyurdu 1 , Orhan Deger 2 , Caner Karahan 2 , Gamze C¸ an 3 & Mu¨nir Telatar 1 1 Faculty of Medicine, Department of Internal Medicine; 2 Department of Biochemistry; 3 Department of Public Health, Karadeniz Technical University, Trabzon, Turkey Accepted in revised form 30 May 2002 Abstract. Objective: The purposes of this study were to determine the prevalence of gestational diabetes mellitus (GDM) in Trabzon city of Turkey and to identify appropriate risk factors for gestational dia- betes in pregnant mothers. Research design and methods: Eight hundred and seven adult pregnant women were screened for GDM with a 1-hour, 50 g oral glucose challenge test (GCT). Three-hour, 100 g oral glucose tolerance tests (GTTs) were performed on screen-positive women. Results: Of the 807 preg- nancies screened, 59 (7.3%) had an initial oral GCT result of P140 mg/dl. Diagnostic testing with the oral GTT was performed on the 59 screen-positive gravid women. Of those tested, 10 were diagnosed with GDM on the basis of greater P2 criteria over 3 hours, for a prevalence of 1.23%. Significant asso- ciations were found between age, body mass index (BMI) and GDM positivity (p < 0.01 and p < 0.05; respectively). The prevalence of GDM was associated with diastolic blood pressure (DBP) and weeks’ ges- tation ðp < 0:05Þ. There was no significant associa- tion between increased BMI, systolic blood pressure, number of pregnancies and GDM positivity. In ad- dition, the birth weights of the babies born to mothers with GDM were significantly higher than those of the non-diabetic healthy mothers’ babies ðp < 0:001Þ. Conclusions: The prevalence of GDM in a Turkish population was low. The prevalence of GDM showed an increase with the ages of pregnant women, gestational age and DBP. This study dem- onstrates that the universal screening for GDM is not mandatory in our pregnant population. The cost of universal screening may be prohibitive in our popu- lation. Large prospective studies are needed to better analyze outcome data and efficacy of screening in adult pregnancies. Key words: Gestational diabetes mellitus, Pregnancy Introduction Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during the current preg- nancy [1]. Gestational diabetes is associated with an excess incidence of fetal macrosomia, preeclampsia and cesarean section in the index pregnancy [2, 3]. The classic work of O’Sullivan and Mahan [4] and O’Sullivan et al. [5] confirmed GDM as a precursor of adult-onset diabetes mellitus, and on long-term fol- low-up, type 2 diabetes mellitus develops in as many as 50% of women who have ever had gestational diabetes [6]. The prevalence of gestational diabetes is not well established and has varied from 3 to 12% in pub- lished studies [7, 8] depending on the genetic char- acteristics and environment of the population under study, screening and diagnostic methods employed as well as on prevalence of type 2 diabetes mellitus [9]. Classic risk factors identify a population of women at risk for gestational diabetes (e.g., obesity, family history of diabetes, family history of macrosomia, or previous poor obstetric history); however, these risk factors identify only 50% of women diagnosed as having gestational diabetes [10]. Current screening recommendations for GDM are controversial. Traditionally, women have been screened on the basis of risk factors such as family history of diabetes, glycosuria, or a prior history of GDM, stillbirth, or fetal macrosomia [11]. The American College of Obstetricians and Gynecologists (ACOG) has suggested that selective screening may be appropriate in some clinical settings, whereas uni- versal screening may be more appropriate in others [12]. ACOG in their most recent technical bulletin on the subject also specifically states that there are no data to support the benefit of routine screening. The purposes of this study were to determine the prevalence of GDM in Trabzon city of Turkey and to identify appropriate risk factors for gestational dia- betes in adult gravidas. European Journal of Epidemiology 18: 39–43, 2003. Ó 2003 Kluwer Academic Publishers. Printed in the Netherlands.