Introduction: Gestational Diabetes (GDM) is associated with myriad maternal and fetal complications. Pacific Islanders are known to be at increased risk for GDM and this is compounded by high levels of pregnancy obesity. Adequate screening for GDM is key to identify cases and act preventatively to ameliorate the associated risks. In a clinical audit, we aimed to evaluate the adequacy of GDM screening among pregnant women in American Samoa.
Method: Data were extracted in a medical record review undertaken in American Samoa June-August 2009. Clinical records of 622 women were reviewed to determine: (a) whether or not the patient was screened for GDM, (b) in which week of gestation this screening occurred, and (c) what type of GDM screening the patient received. Chi-square and independent samples t-tests were used to identify differences in socio-demographic characteristics between those who were screened adequately and those who were not.
Findings: Few women (16.2%) received adequate GDM screening. Many women received a first prenatal visit GDM screen in accordance with local guidelines, but very few women received a follow-up oral glucose tolerance test (OGTT) in the recommended 24-28 week testing period. There were no socio-demographic differences between those who were adequately screened and those who were not.Conclusion: Despite the presence of clear guidelines for GDM screening in American Samoa, this study highlights the critical need for improved screening in this high risk population. The causes of inadequate screening, which are currently unknown, must be identified and interventions should be targeted at both the clinician and patient to improve the adequacy of GDM screening in this setting.