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Screening for gestational diabetes
Since 2012, pregnant women without known diabetes in Germany have been offered a two-stage screening for gestational diabetes in accordance with the maternity directive of the G-BA (maternity directive of the G-BA). The screening consists of a pre-test using 50g of glucose (glucose challenge test, GCT), which should be carried out between the 24th and 28th week of pregnancy, regardless of the time of day and recent food intake. If the result is abnormal, a diagnostic test using 125g of glucose (oral glucose tolerance test, oGTT) is carried out. In contrast to the maternity directive of the G-BA, the German guideline for gestational diabetes recommends a one-step screening approach using the diagnostic test (Schäfer-Graf et al. 2018).
Key messages
- More than 90% of pregnant women who gave birth in a hospital in 2020 were tested at least once for gestational diabetes.
- Since 2016, the proportion of women who gave birth in a hospital and received a test for gestational diabetes has increased.
- Two-thirds of women with hospital birth only received the pre-test, 18.8% received both the pre-test and the diagnostic test, and 7.8% only received the diagnostic test.
trend
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cross-section
By state
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By gender
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By age
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By regional socioeconomical deprivation
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Results
In 2020, 93.3% of women who gave birth in a hospital were tested at least once for gestational diabetes. Of these, 66.6% only received a pre-test, 7.8% only the diagnostic test, and 18.8% both tests. In the younger age groups (up to 35 years), more than two thirds of women only received the pre-test. This proportion is lower in the older age groups and the proportion of women who only received the diagnostic test or underwent both tests is correspondingly higher. A comparison over time shows that the proportion of women with hospital birth without a documented test fell from 16.6% in 2016 to 6.7% in 2020, and that the proportion of women who received at least one test increased over the same period (2016: 83.4%, 2020: 93.3%). This trend can be seen across all federal states, however in 2020 there is still a substantial difference of women tested for gestational diabetes between the federal states. In the eastern German states, around 95% receive at least one test for gestational diabetes in 2020, while in Bremen only 88.7% receive a test. In contrast, no difference can be observed depending on the regional socioeconomic deprivation.
Conclusion
The screening participation has increased over time, and documentation shows that 9 out of 10 women are tested for gestational diabetes. In an earlier analysis using data from the KBV from 2014/15, this proportion was significantly lower at 80.8% (Melchior et al. 2017). The screening participation has then increased over time, as evidenced by follow-up analyses by KBV. The majority of women follows the recommendation of the maternity directive and they either only received a pre-test or a pre-test followed by a diagnostic test. Only a smaller proportion of pregnant women only received the diagnostic test. Further analyses should address which women are currently not reached by screening and whether they differ in important risk factors for gestational diabetes.