{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:18:17Z","timestamp":1787167097948,"version":"build-2736575974"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Directorate-general Development Cooperation and Humanitarian Aid Belgium through the Institute of Tropical Medicine, Antwerp, Belgium"},{"name":"Tanzania Diabetes association"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Screening for hyperglycaemia in pregnancy (HIP) is an entry point to a healthy pregnancy and childbirth for both the woman and child, and offers a window of opportunity for the prevention of cardio-metabolic complications over the life-course of the woman and newborn. In Tanzania, two different screening algorithms to identify women with HIP are recommended, with no clear understanding of which performs better. We aimed to determine the prevalence of hyperglycemia in pregnancy (HIP) among antenatal care (ANC) attendees and the accuracy of HIP screening tests. A cross-sectional study design involving 970 women attending ANC clinic was done in two district hospitals (Mbagala Rangi Tatu and Kisarawe) of Tanzania between June and October 2024. Socio-demographic, obstetric characteristics, and anthropometric parameters were obtained from study participants. A checklist screening test (CST) for gestational diabetes mellitus (GDM), defined by the Tanzanian standard treatment guideline, was used. We tested for glycosuria and two-hour 75-gram oral glucose tolerance test (OGTT) on every study participant. We conducted descriptive statistics and sensitivity analysis to determine the prevalence of HIP and assess the screening performance of CST and glycosuria test against OGTT using World Health Organization 2013 diagnostic criteria for GDM. The prevalence of HIP was 10% (7.9% GDM and 2.1% diabetes in pregnancy). Glycosuria test missed all women with GDM and could identify only 20% with diabetes in pregnancy. The CST had a sensitivity and specificity of 72.2% (62.1-80.8, 95%CI) and 32.4% (29.3-35.6, 95%CI), respectively, while the glycosuria test had 4.1% (1.1-10.2, 95%CI) and 97.1% (95.8-98.1, 95%CI). The area under the receiver operator characteristic curve for both the CST 0.523 (0.48-0.57,95%CI) and glycosuria test 0.506 (0.49-0.53,95%CI) was low, indicating their poor discriminatory performance for HIP. One in every ten women had HIP. The CST is a better first-step screening test than the glycosuria test based on sensitivity.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004696","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T17:27:02Z","timestamp":1760635622000},"page":"e0004696","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hyperglycemia in pregnancy: A sensitivity analysis study of two recommended screening tests in Tanzania"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1130-9279","authenticated-orcid":true,"given":"Amani Idris","family":"Kikula","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3309-5395","authenticated-orcid":true,"given":"Kaushik","family":"Ramaiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5205-624X","authenticated-orcid":true,"given":"Nathanael","family":"Sirili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1238-7053","authenticated-orcid":true,"given":"Matilda","family":"Mkonyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rukia","family":"Msumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Macha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8090-3298","authenticated-orcid":true,"given":"Andrea B.","family":"Pembe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0096-6238","authenticated-orcid":true,"given":"Jos\u00e9 L.","family":"Pe\u00f1alvo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8595-365X","authenticated-orcid":true,"given":"Lenka","family":"Be\u0148ov\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"pgph.0004696.ref001","unstructured":"Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division [Internet]. [cited 2025 Jan 7]. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240068759"},{"key":"pgph.0004696.ref002","first-page":"203","article-title":"Obstetric transition in the World Health Organization Multicountry Survey on Maternal and Newborn Health: exploring pathways for maternal mortality reduction","volume":"37","author":"SDC Chaves","year":"2015","journal-title":"Rev Panam Salud Publica"},{"key":"pgph.0004696.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/1471-0528.12735","article-title":"Obstetric transition: the pathway towards ending preventable maternal deaths","volume":"121","author":"JP Souza","year":"2014","journal-title":"BJOG"},{"issue":"4","key":"pgph.0004696.ref004","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(24)00560-6","article-title":"Global and regional causes of maternal deaths 2009-20: a WHO systematic analysis","volume":"13","author":"JA Cresswell","year":"2025","journal-title":"Lancet Glob Health"},{"key":"pgph.0004696.ref005","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.fct.2018.08.071","article-title":"Causes and solutions to \u201cglobesity\u201d: The new fa(s)t alarming global epidemic","volume":"121","author":"LV Vasileva","year":"2018","journal-title":"Food Chem Toxicol"},{"key":"pgph.0004696.ref006","unstructured":"Obesity and overweight [Internet]. [cited 2025 Jan 7]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight"},{"key":"pgph.0004696.ref007","unstructured":"World Obesity Federation Global Obesity Observatory [Internet]. World Obesity Day Atlases | Obesity Atlas. 2024. [cited 2025 Feb 26]. Available from: https:\/\/data.worldobesity.org\/publications\/?cat=22"},{"issue":"1","key":"pgph.0004696.ref008","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s12902-020-00631-3","article-title":"Obesity epidemic in urban Tanzania: a public health calamity in an already overwhelmed and fragmented health system","volume":"20","author":"P Pallangyo","year":"2020","journal-title":"BMC Endocr Disord"},{"issue":"1","key":"pgph.0004696.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0297665","article-title":"Prevalence, knowledge and practices on prevention and management of overweight and obesity among adults in Dodoma City, Tanzania","volume":"19","author":"SS Msollo","year":"2024","journal-title":"PLoS One"},{"key":"pgph.0004696.ref010","article-title":"Increasing prevalence of overweight and obesity among Tanzanian women of reproductive age intending to conceive: evidence from three Demographic Health Surveys, 2004-2016","volume":"7","author":"AI Kikula","year":"2023","journal-title":"J Glob Health Rep"},{"key":"pgph.0004696.ref011","doi-asserted-by":"crossref","unstructured":"Maternal Obesity and Risk of Gestational Diabetes Mellitus | Diabetes Care | American Diabetes Association [Internet]. [cited 2025 Feb 26]. Available from: https:\/\/diabetesjournals.org\/care\/article\/30\/8\/2070\/28574\/Maternal-Obesity-and-Risk-of-Gestational-Diabetes","DOI":"10.2337\/dc06-2559a"},{"key":"pgph.0004696.ref012","article-title":"The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care","volume":"131","author":"M Hod","year":"2015","journal-title":"Int J Gynecol Obst"},{"issue":"10448","key":"pgph.0004696.ref013","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/S0140-6736(24)00827-4","article-title":"Pathophysiology from preconception, during pregnancy, and beyond","volume":"404","author":"MF Hivert","year":"2024","journal-title":"The Lancet"},{"issue":"10448","key":"pgph.0004696.ref014","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S0140-6736(24)00826-2","article-title":"Call to action for a life course approach","volume":"404","author":"D Simmons","year":"2024","journal-title":"Lancet"},{"key":"pgph.0004696.ref015","unstructured":"WHO Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. 2013. [cited 2025 Jan 7]. 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Tanzania demographic and health survey 2022. 2023. Available from: https:\/\/www.dhsprogram.com\/publications\/publication-FR382-DHS-Final-Reports.cfm"},{"key":"pgph.0004696.ref021","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.diabres.2018.05.003","article-title":"Capacity and capability of Tanzania health facilities to diagnose and manage diabetes mellitus in pregnancy","volume":"145","author":"KL Ramaiya","year":"2018","journal-title":"Diabetes Res Clin Pract"},{"key":"pgph.0004696.ref022","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jbi.2014.02.013","article-title":"Sample size estimation in diagnostic test studies of biomedical informatics","volume":"48","author":"K Hajian-Tilaki","year":"2014","journal-title":"J Biomed Inform"},{"issue":"2","key":"pgph.0004696.ref023","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1111\/tmi.13018","article-title":"Prevalence, predictors and challenges of gestational diabetes mellitus screening among pregnant women in northern Tanzania","volume":"23","author":"HI Njete","year":"2018","journal-title":"Trop Med Int Health"},{"key":"pgph.0004696.ref024","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.diabres.2018.05.001","article-title":"Gestational diabetes mellitus risk score: a practical tool to predict gestational diabetes mellitus risk in Tanzania","volume":"145","author":"AP Nombo","year":"2018","journal-title":"Diabetes Res Clin Pract"},{"issue":"1","key":"pgph.0004696.ref025","doi-asserted-by":"crossref","DOI":"10.1136\/bmjdrc-2017-000493","article-title":"Accuracy of glycosuria, random blood glucose and risk factors as selective screening tools for gestational diabetes mellitus in comparison with universal diagnosing","volume":"6","author":"F Agbozo","year":"2018","journal-title":"BMJ Open Diabetes Res Care"},{"key":"pgph.0004696.ref026","unstructured":"Rapilose-OGTT-Product-Data-Sheet-v1.5-20231212-1.pdf [Internet]. [cited 2024 Dec 11]. Available from: https:\/\/www.penlanhealthcare.com\/wp-content\/uploads\/2024\/04\/Rapilose-OGTT-Product-Data-Sheet-v1.5-20231212-1.pdf"},{"issue":"3","key":"pgph.0004696.ref027","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1177\/1932296816672237","article-title":"Comparative accuracy of 17 point-of-care glucose meters","volume":"11","author":"L Ekhlaspour","year":"2016","journal-title":"J Diabetes Sci Technol"},{"issue":"3","key":"pgph.0004696.ref028","first-page":"198","article-title":"Accuracy of self monitoring blood glucose systems in a clinical setting: application of new planned ISO-standards","volume":"7","author":"C Hasslacher","year":"2012","journal-title":"Diabetol Stoffwechsel"},{"key":"pgph.0004696.ref029","doi-asserted-by":"crossref","first-page":"612","DOI":"10.26719\/2002.8.4-5.612","article-title":"Mid upper arm and calf circumferences as indicators of nutritional status in women of reproductive age","volume":"8","author":"T Khadivzadeh","year":"2002","journal-title":"East Mediterr Health J"},{"issue":"1","key":"pgph.0004696.ref030","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1186\/s12884-019-2343-2","article-title":"Current guidelines on the management of gestational diabetes mellitus: a content analysis and appraisal","volume":"19","author":"M Zhang","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"issue":"5","key":"pgph.0004696.ref031","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/S2213-8587(23)00092-X","article-title":"Defining gestational diabetes: not just about cutoffs","volume":"11","author":"D Simmons","year":"2023","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"pgph.0004696.ref032","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S2213-8587(23)00328-5","article-title":"Is a new discussion about diagnosis of gestational diabetes needed?","volume":"12","author":"G Desoye","year":"2024","journal-title":"Lancet Diabetes 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guidelines & behavior change: a systematic review and a consideration on effectiveness in healthcare","volume":"151","author":"S Gandolfi","year":"2025","journal-title":"Health Policy"},{"issue":"2","key":"pgph.0004696.ref037","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003664","article-title":"Facilitators and barriers for healthcare workers\u2019 adherence to the national nutritional guidelines for people living with HIV in Dar-es-Salaam: a mixed-method study","volume":"5","author":"F Mwakasungura","year":"2025","journal-title":"PLOS Glob Public Health"},{"key":"pgph.0004696.ref038","doi-asserted-by":"crossref","first-page":"1918583","DOI":"10.1155\/2020\/1918583","article-title":"Adherence, awareness, access, and use of standard diagnosis and treatment guideline for malaria case management among healthcare workers in Meatu, Tanzania","volume":"2020","author":"A Budimu","year":"2020","journal-title":"J Trop Med"},{"issue":"1","key":"pgph.0004696.ref039","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1186\/s12913-021-06257-y","article-title":"Adherence to standard treatment guidelines among prescribers in primary healthcare facilities in the Dodoma region of Tanzania","volume":"21","author":"K Wiedenmayer","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pgph.0004696.ref040","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1186\/s12884-016-1143-1","article-title":"\u201cWhy screen if we cannot follow-up and manage?\u201d Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey","volume":"16","author":"B Utz","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"pgph.0004696.ref041","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1186\/s12884-022-04838-1","article-title":"Simple method for identification of women at risk of gestational diabetes 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[cited 2025 Mar 11]. Available from: https:\/\/www.nature.com\/articles\/s41746-025-01527-z"},{"issue":"10448","key":"pgph.0004696.ref043","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/S0140-6736(24)00825-0","article-title":"Epidemiology and management of gestational diabetes","volume":"404","author":"A Sweeting","year":"2024","journal-title":"Lancet"},{"key":"pgph.0004696.ref044","doi-asserted-by":"crossref","first-page":"109050","DOI":"10.1016\/j.diabres.2021.109050","article-title":"IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group\u2019s Criteria","volume":"183","author":"H Wang","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"issue":"3","key":"pgph.0004696.ref045","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/j.1464-5491.1991.tb01581.x","article-title":"No deterioration of oral glucose tolerance during pregnancy in rural Tanzania","volume":"8","author":"AB Swai","year":"1991","journal-title":"Diabet Med"},{"issue":"9","key":"pgph.0004696.ref046","doi-asserted-by":"crossref","first-page":"3109","DOI":"10.3390\/ijerph17093109","article-title":"High prevalence of gestational diabetes mellitus in rural Tanzania-diagnosis mainly based on fasting blood glucose from oral glucose tolerance test","volume":"17","author":"LG Grunnet","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"pgph.0004696.ref047","doi-asserted-by":"crossref","first-page":"82","DOI":"10.4314\/gmj.v54i2.5","article-title":"Prevalence and associated factors of gestational diabetes mellitus among rural pregnant women in southern Tanzania","volume":"54","author":"FP Mghanga","year":"2020","journal-title":"Ghana Med J"},{"key":"pgph.0004696.ref048","doi-asserted-by":"crossref","first-page":"101294","DOI":"10.1016\/j.eclinm.2022.101294","article-title":"The life course perspective of gestational diabetes: an opportunity for the prevention of diabetes and heart disease in women","volume":"45","author":"J Fu","year":"2022","journal-title":"EClinicalMedicine"},{"key":"pgph.0004696.ref049","first-page":"15","article-title":"Diagnosis of gestational diabetes mellitus in the community","volume":"60","author":"V Seshiah","year":"2012","journal-title":"J Assoc Physicians India"},{"issue":"1","key":"pgph.0004696.ref050","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s00592-008-0060-9","article-title":"A single test procedure to diagnose gestational diabetes mellitus","volume":"46","author":"C Anjalakshi","year":"2009","journal-title":"Acta Diabetol"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004696","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T17:27:10Z","timestamp":1760635630000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004696"}},"subtitle":[],"editor":[{"given":"Nicola","family":"Hawley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":50,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0004696","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]}}}