Optimization of referral routing for pregnant women with risk factors for gestational diabetes at the primary health care level: development and implementation of a standardized checklist

Abstract

Relevance: Gestational diabetes mellitus (GDM) is a pressing medical and social problem, as its development is associated with an increased risk of obstetric complications and adverse perinatal outcomes. The effectiveness of prevention and early detection largely depends on the quality of primary health care (PHC) organization, where a pregnant woman’s first visit and risk-factor assessment take place.

Mechanisms for early identification of at-risk patients and their timely referral for specialized examinations still need improvement. Developing and implementing a standardized checklist at the PHC level will standardize the GDM risk assessment process, improve continuity between stages of medical care, and create conditions for earlier initiation of preventive and therapeutic measures.

The study aimed to develop an evidence-based clinical checklist and referral algorithm for the early identification of pregnant women at high risk of GDM.

Materials and Methods: Based on a retrospective cohort study of 600 delivery records (300 with GDM, 300 controls), we identified GDM predictors using multivariate logistic regression and ROC analysis.

Results: We developed a prognostic risk scale for GDM (AUC = 0.849). Cut-off points and score weights for predictors were: chronic arterial hypertension (3 points), previous GDM(3 points), BMI ≥ 30 kg/m²(3 points), HbA1c ≥ 5.51%(2 points), fasting glucose ≥ 4.81 mmol/L(2 points), positive family history(2 points), age ≥ 30 years(1 point). A total score ≥ 3 showed high sensitivity and specificity for GDM development. We proposed an early referral algorithm for pregnant women before 12 weeks of gestation.

Conclusion: Implementing the modified checklist in practice allows general practitioners to shift from late screening to personalized targeted prevention of GDM.