Gestational Diabetes Screening

Feldman, R. Klara; Tieu, Ryan; Yasumura, Lyn

doi:10.1097/aog.0000000000001132

Cited by 96 publications

(37 citation statements)

References 16 publications

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“…A retrospective analysis by Ethridge et al (5) also suggested women who would be diagnosed with GDM based on IADPSG criteria have significant increases in adverse pregnancy outcomes compared with women undergoing normal GDM screening. These findings contrast with other data, including a recent publication by Feldman et al (7), which cited an increased number of women diagnosed with GDM when using IADPSG criteria, but no difference among large-for-gestational-age newborns or those with macrosomia when either the CC or IADPSG criteria were used. Because of the lack of clarity regarding the additional benefit of universal one-step testing with IADPSG criteria, ACOG continues to recommend traditional testing with a 50-g screen and a diagnostic 100-g OGTT (2).…”

Section: Discussioncontrasting

confidence: 99%

Maternal and Neonatal Morbidity for Women Who Would Be Added to the Diagnosis of GDM Using IADPSG Criteria: A Secondary Analysis of the Hyperglycemia and Adverse Pregnancy Outcome Study

et al. 2016

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OBJECTIVETo assess the frequency of adverse outcomes for women who are diagnosed with gestational diabetes mellitus (GDM) by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria using data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study.RESEARCH DESIGN AND METHODSThis is a secondary analysis from the North American HAPO study centers. Glucose measurements from a 75-g oral glucose tolerance test were used to group participants into three nonoverlapping categories: GDM based on Carpenter-Coustan (CC) criteria (also GDM based on IADPSG criteria), GDM diagnosed based on IADPSG criteria but not CC criteria, and no GDM. Newborn outcomes included birth weight, cord C-peptide, and newborn percentage fat above the 90th percentile; maternal outcomes included primary cesarean delivery and preeclampsia. Outcome frequencies were compared using multiple logistic regression, adjusting for predefined covariates.RESULTSAmong 25,505 HAPO study participants, 6,159 blinded participants from North American centers were included. Of these, 81% had normal glucose testing, 4.2% had GDM based on CC criteria, and 14.3% had GDM based on IADPSG criteria but not CC criteria. Compared with women with no GDM, those diagnosed with GDM based on IADPSG criteria had adjusted odds ratios (95% CIs) for birth weight, cord C-peptide, and newborn percentage fat above the 90th percentile, as well as primary cesarean delivery and preeclampsia, of 1.87 (1.50–2.34), 2.00 (1.54–2.58), 1.73 (1.35–2.23), 1.31 (1.07–1.60), and 1.73 (1.32–2.27), respectively.CONCLUSIONSWomen diagnosed with GDM based on IADPSG criteria had higher adverse outcome frequencies compared with women with no GDM. These data underscore the need for research to assess the effect of treatment to improve outcomes in such women.

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Section: Discussioncontrasting

confidence: 99%

Maternal and Neonatal Morbidity for Women Who Would Be Added to the Diagnosis of GDM Using IADPSG Criteria: A Secondary Analysis of the Hyperglycemia and Adverse Pregnancy Outcome Study

et al. 2016

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“…In our search of the literature we found only two retrospective cohorts that compared the treatment effect on maternal and neonatal outcomes between groups who received Carpenter-Coustan versus IADPSG testing. 6–7 Huang and Hsieh 6 found that, compared to women who underwent Carpenter-Coustan testing, those who underwent IADPSG testing had lower rates of LGA (6.3% vs. 7.8%, adjusted OR 0.74, 95% CI 0.61–0.89), but had no change in the rate of cesarean delivery, NICU admission, or preeclampsia as it was underpowered to identify differences in many of these outcomes. A second before-and-after cohort study by Feldman et al 7 found no differences in rates of LGA neonates in a Carpenter-Coustan versus a IADPSG epoch.…”

Section: Discussionmentioning

confidence: 99%

“…Two large-cohort studies were published since the consensus conference that demonstrated contradictory results both for their primary outcome of large-for-gestational-age neonates as well as for select secondary outcomes, including the total rate of cesarean delivery, primary cesarean delivery, macrosomia and neonatal intensive care unit admission. 6–7 …”

mentioning

confidence: 99%

Association Between Type of Screening for Gestational Diabetes Mellitus and Cesarean Delivery

Palatnik

Swanson

Churchill

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To compare maternal and neonatal outcomes using two different testing strategies for gestational diabetes mellitus (GDM) diagnosis: The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan approaches. Specifically, we wanted to compare the rates of cesarean delivery between the two epochs. Methods This was a retrospective cohort study of women with a singleton pregnancy delivering at ≥ 370/7 weeks, between 2010 and 2015, in a single tertiary care center. IADPSG testing was used for GDM diagnosis from December 2010 until July 2013 when institutional guidelines changed to Carpenter-Coustan testing. Maternal and neonatal outcomes were compared between these two different epochs using bivariable and multivariable analyses. The primary outcome was the frequency of cesarean delivery. Results The analysis included a total of 23,509 women: 14,074 (60%) from the IADPSG epoch and 9,435 (40%) from the Carpenter-Coustan epoch. The incidence of GDM diagnosis was higher using IADPSG compared to Carpenter-Coustan criteria (8.3% vs. 7.5%, p=0.042). The total (27.0% vs. 25.5% p=0.022) as well as primary cesarean delivery rates (19.1% vs. 18.0%, p=0.041) were higher during the IADPSG epoch. The rates of total (39.1% vs. 37.5%, p=0.594) and primary (27.3% vs. 27.0%, p=0.903) cesarean delivery among women with GDM did not differ between the two epochs. Secondary outcomes of shoulder dystocia (2.5% vs 2.1%, p=0.043) and NICU admission (3.2% vs 2.0%, p<0.001) also were significantly higher in women screened during the IADPSG epoch, whereas hypertensive disease of pregnancy (6.9% vs 7.7%, p=0.018) was less frequent during the IADPSG epoch. These findings persisted after adjusting for potential confounding factors. Conclusion Compared with testing using the Carpenter-Coustan criteria, the IADPSG criteria for diagnosis of GDM were associated with higher rates of GDM, cesarean delivery, shoulder dystocia, and NICU admission. Provider knowledge of GDM diagnosis might have affected decision making regarding the route of delivery.

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“…(4) Prospective non-RCTs or retrospective studies comparing incidence of GDM and/or outcomes between the One-Step and Two-Step methods: we found 9 retrospective studies comparing the One-Step approach with IADPSG criteria and Two-Step approach with ACOG criteria (Table 4) [22–30]. Regarding GDM rate, the incidence is higher for women undergoing the One-Step test in all the studies analyzing this issue.…”

Section: Screening Controversiesmentioning

confidence: 99%

Scientific Evidence for Different Options for GDM Screening and Management: Controversies and Review of the Literature

Berghella

2017

BioMed Research International

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Background. Gestational diabetes (GDM) affects up to 7% of pregnant women and is associated with several maternal and perinatal morbidities. International organizations suggest several different recommendations regarding how to screen and to manage GDM. Objective. We aimed to analyze the most important and employed guidelines about screening and management of GDM and we investigated existing related literature. Results. We found several different criteria for screening for GDM, for monitoring GDM, and for starting pharmacological therapy. When using IADPSG criteria, GDM rate increased, perinatal outcomes improved, and screening became cost-effective. Compared to no treatment, treatment of women meeting criteria for GDM by IADPSG criteria but not by other less strict criteria has limited evidence for an effect on adverse pregnancy outcomes.

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Gestational Diabetes Screening

Cited by 96 publications

References 16 publications

Maternal and Neonatal Morbidity for Women Who Would Be Added to the Diagnosis of GDM Using IADPSG Criteria: A Secondary Analysis of the Hyperglycemia and Adverse Pregnancy Outcome Study

Maternal and Neonatal Morbidity for Women Who Would Be Added to the Diagnosis of GDM Using IADPSG Criteria: A Secondary Analysis of the Hyperglycemia and Adverse Pregnancy Outcome Study

Association Between Type of Screening for Gestational Diabetes Mellitus and Cesarean Delivery

Scientific Evidence for Different Options for GDM Screening and Management: Controversies and Review of the Literature

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