Evidence map›Paper›PMID 33849467›Full record

ArticleBMC pregnancy and childbirth2021

Implementation of a first-trimester prognostic model to improve screening for gestational diabetes mellitus.

Fieke van Hoorn, Maria P H Koster, Anneke Kwee, Floris Groenendaal, Arie Franx, Mireille N Bekker, RESPECT 2 study group

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC pregnancy and childbirth, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Fieke van HoornDepartment of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, Utrecht, 3584 EA, the Netherlands.ORCID https://orcid.org/0000-0002-8526-2303
Maria P H KosterDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands.ORCID https://orcid.org/0000-0002-8942-6045
Anneke KweeDepartment of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, Utrecht, 3584 EA, the Netherlands.ORCID https://orcid.org/0000-0002-5873-7246
Floris GroenendaalDepartment of Neonatology, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, Utrecht, 3584 EA, the Netherlands.ORCID https://orcid.org/0000-0002-9284-1637
Arie FranxDepartment of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, Utrecht, 3584 EA, the Netherlands.ORCID https://orcid.org/0000-0001-8801-5546
Mireille N BekkerDepartment of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, Utrecht, 3584 EA, the Netherlands. M.N.Bekker-3@umcutrecht.nl.ORCID https://orcid.org/0000-0002-7372-4291
RESPECT 2 study group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundImprovement in the accuracy of identifying women who are at risk to develop gestational diabetes mellitus (GDM) is warranted, since timely diagnosis and treatment improves the outcomes of this common pregnancy disorder. Although prognostic models for GDM are externally validated and outperform current risk factor based selective approaches, there is little known about the impact of such models in day-to-day obstetric care.

methodsA prognostic model was implemented as a directive clinical prediction rule, classifying women as low- or high-risk for GDM, with subsequent distinctive care pathways including selective midpregnancy testing for GDM in high-risk women in a prospective multicenter birth cohort comprising 1073 pregnant women without pre-existing diabetes and 60 obstetric healthcare professionals included in nine independent midwifery practices and three hospitals in the Netherlands (effectiveness-implementation hybrid type 2 study). Model performance (c-statistic) and implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability) were evaluated after 6 months by indicators and implementation instruments (NoMAD; MIDI).

resultsThe adherence to the prognostic model (c-statistic 0.85 (95%CI 0.81-0.90)) was 95% (n = 1021). Healthcare professionals scored 3.7 (IQR 3.3-4.0) on implementation instruments on a 5-point Likert scale. Important facilitators were knowledge, willingness and confidence to use the model, client cooperation and opportunities for reconfiguration. Identified barriers mostly related to operational and organizational issues. Regardless of risk-status, pregnant women appreciated first-trimester information on GDM risk-status and lifestyle advice to achieve risk reduction, respectively 89% (n = 556) and 90% (n = 564)).

conclusionsThe prognostic model was successfully implemented and well received by healthcare professionals and pregnant women. Prognostic models should be recommended for adoption in guidelines.

Indexed as

Models, StatisticalAdultBlood GlucoseDiabetes, GestationalFeasibility StudiesFemaleFollow-Up StudiesGuideline AdherenceHealth Plan ImplementationHealthy LifestyleHumansMass ScreeningMedical History TakingMiddle AgedNetherlandsPractice Guidelines as TopicBlood GlucoseClinical prediction ruleGestational diabetes mellitusImpact analysisImplementationMIDINoMADNormalization process theoryPrognostic modelRisk communicationSelective screening

Identifiers

PMID33849467
PMCPMC8045273

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.