Selective screening for gestational diabetes mellitus in adolescent pregnancies

Objective: It is unclear whether it is cost-effective to universally screen adolescent gravidas for gestational diabetes mellitus (GDM). Our objective was to identify the prevalence of gestational diabetes in our adolescent population and to review risk factors that would most easily identify a subset of adolescent patients at greatest risk for the development of gestational. diabetes. Methods: Six hundred thirty-two adolescents were identified from 11,486 deliveries in our institution through international Classification of Diseases (9th edition) codes. Eleven of those adolescents had GDR I. Their charts and those of a representative group of nondiabetic adolescent gravidas were analyzed for GDR;I risk factors, including race/ethnicity, body mass index (BMI), family history of diabetes, other medical disorders, and previous history of GDM, macrosomia, stillbirths, or anomalous fetus. Statistical analyses used chi(2) and Student t tests as appropriate. Results: The prevalence of GDM among adolescent gravidas was 1.7%. No difference was identified between the adolescent pregnancies with GDM and the comparison group for race/ethnicity, family history, or presence of medical disorders. Risk factors requiring a previous obstetric history could not be evaluated adequately because of the high prevalence of nulliparas. There was a higher prevalence of BMI over 27 in adolescents with GDM(P < .001). Conclusion: Body mass index is an important risk factor for the development of gestational diabetes in adolescent gravidas. We recommend that selective screening for GDM of adolescent gravidas be performed on the basis of BMI. (C) 1999 by The American College of Obstetricians and Gynecologists.