One-Step Compared With Two-Step Gestational Diabetes Screening and Pregnancy Outcomes

Brady, Matthew J.; Hensel, Drew M.; Paul, Rachel; Doering, Michelle; Kelly, Jeannie C.; Frolova, Antonina I.; Odibo, Anthony O.; Barry, Valene Garr; Powe, Camille E.; Raghuraman, Nandini; Tuuli, Methodius G.; Carter, Ebony B.

doi:10.1097/aog.0000000000004943

Cited by 13 publications

(12 citation statements)

References 33 publications

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“…That evidence has changed: there are now at least four randomised trials which have compared difference diagnostic processes and not found clear benefits to the expanded definitions. A recent systematic review (23) of GDM screening trials identified 2 of the 4 trials discussed here (the other two we discuss were published subsequent to their search date) but reached similar conclusions. However, an individual patient meta-analysis of all trials should be considered.…”

Section: Discussionsupporting

confidence: 54%

Recent trials comparing definitions of gestational diabetes: a need to step back

Glasziou¹

2022

Preprint

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BackgroundIn 2013, the Australian Diabetes In Pregnancy Society (ADIPS) recommended an expanded definition for gestational diabetes (GDM). The RACGP, among other representative groups, questioned the evidence for change and continues to recommend the previous 2-step testing process using higher glucose cut-offs. ObjectiveThe changed definition has doubled the proportion of women diagnosed with GDM in Australia, despite Australian non-randomized studies showing no improvement in outcomes.We examined four recent large randomised trials – in the USA, New Zealand, and Iran - which evaluated the impact of GDM definitions on patient-relevant outcomes. All studies found increased numbers of women diagnosed but none found improvement in perinatal or maternal outcomes.DiscussionGiven these trials’ results showing no improvement in outcomes but increased treatment, costs, concerns, and inconvenience to women, the RACGP and others should review the diagnosis of gestational diabetes. Meanwhile general practitioners should continue to offer women the 2-step process.

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Section: Discussionsupporting

confidence: 54%

Recent trials comparing definitions of gestational diabetes: a need to step back

Glasziou¹

2022

Preprint

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“…[35][36][37] Combining results from randomized controlled trials and large, wellconducted observational studies, a recent meta-analysis found equal rates of neonates who were large for gestational age, despite a twofold increase in diagnosis of gestational diabetes with 1-step screening and subsequent treatment. 38 As the authors noted, although it appears that the diagnostic burden of 1-step testing is not justified by differences in pregnancy outcomes, increased diagnosis rates may still have long-term benefits for cardiometabolic health or offspring.…”

Section: Discussionmentioning

confidence: 99%

The effect of changing screening practices and demographics on the incidence of gestational diabetes in British Columbia, 2005–2019

Nethery

Law

Kotaska

et al. 2023

CMAJ

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Background: Rates of gestational diabetes are reported to be increasing in many jurisdictions, but the reasons for this are poorly understood. We sought to evaluate the relative contribution of screening practices for gestational diabetes (including completion and methods of screening) and population characteristics to risk of gestational diabetes in British Columbia, Canada, from 2005 to 2019. Methods:We used a population-based cohort from a provincial registry of perinatal data, linked to laboratory billing records. We used data on screening completion, screening method (1-step 75-g glucose test or 2-step approach of 50-g glucose screening test, followed by a diagnostic test for patients who screen positive) and demographic risk factors. We modelled predicted annual risk for gestational diabetes, sequentially adjusted for screening completion, screening method and risk factors. Results:We included 551 457 pregnancies in the study cohort. The incidence of gestational diabetes more than doub led over the study period, from 7.2% in 2005 to 14.7% in 2019. Screening completion increased from 87.2% in 2005 to 95.5% in 2019. Use of 1-step screening methods increased from 0.0% in 2005 to 39.5% in 2019 among those who were screened. Unadjusted models estimated a 2.04 (95% confidence interval [CI] 1.94-2.13) increased risk of gestational diabetes in 2019 (v. 2005). This increase was 1.89 (95% CI 1.81-1.98) after accounting for the rise in screening completion and 1.34 (95% CI 1.28-1.40) after accounting for changes in screening methods. Further accounting for demographic risk factors (e.g., age, body mass index, prenatal care) had a small impact (increase of 1.25, 95% CI 1.19-1.31).Interpretation: Most of the observed increase in the incidence of gestational diabetes was attributable to changes in screening practices (primarily changes in screening methods) rather than changing population factors. Our findings highlight the importance of understanding variation in screening practices when monitoring incidence rates for gestational diabetes.

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Section: Introductionmentioning

confidence: 99%

“…However, despite several recent large-scale studies, debate continues addressing which of these two clinically recommended screening approaches may better improve pregnancy outcomes (1,(15)(16)(17)(18)(19)(20)(21)(22). Recently, two meta-analyses comparing the One-step and Two-step approaches in terms of adverse pregnancy outcomes were published, which had conflicting results (18,21). Saccone et al (18) in a meta-analysis of four randomized clinical trials (RCTs) (n = 2582 participants), reported that diagnosis of GDM by the One-step approach was associated with better perinatal outcomes, compared to the Two-step approach (18).…”

Section: Introductionmentioning

confidence: 99%

“…( 21 ) in a meta-analyses of four RCTs (n = 24,966 patients) and 13 observational studies (n = 710,677 patients), found that despite a significant increase in GDM diagnosis and treatment with One-step testing, there is no difference in rate of LGA neonates compared with Two-step testing among RCTs. Additionally, in the analysis of high-quality RCTs and observational studies, One-step testing was associated with a lower rate of LGA neonates (pooled RR 0.97; 95% CI 0.95–0.98), but higher rates of GDM diagnosis, treatment, NICU admission, and neonatal hypoglycemia ( 21 ).…”

Section: Introductionmentioning

confidence: 99%

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One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial

et al. 2023

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ObjectivesThere is considerable worldwide controversy regarding optimal screening and diagnostic approaches for GDM. This study aimed to compare the prevalence, maternal and neonatal outcomes of a One-step with a Two-step approach for the screening and diagnosis of GDM in a large community sample of pregnant women.MethodsWe conducted a secondary analysis of a randomized community non-inferiority trial of GDM screening in Iran. For the current study, all pregnant women who met the inclusion criteria were randomized into two groups for GDM screening. The first group of women (n = 14611) was screened by a One-step screening approach [75-g 2-h oral glucose tolerance test (OGTT)] and the second group (n = 14160) by a Two-step method (the 50-g glucose challenge test followed by the 100-g OGTT). All study participants were followed up until delivery, and the adverse maternal and neonatal outcomes were recorded in detail.ResultsGDM was diagnosed in 9.3% of the pregnant women who were assigned to the One-step and in 5.4% of those assigned to the Two-step approach with a statistically significant difference between them (p < 0.001). Intention-to-treat analyses showed no significant differences between the One-step and the Two-step group in the unadjusted risks of the adverse pregnancy outcomes of macrosomia, primary cesarean-section, preterm birth, hypoglycemia, hypocalcemia, hyperbilirubinemia, preeclampsia, neonatal intensive care unit admission, birth trauma, low birth weight, and intrauterine fetal death. Results remained unchanged after adjustment for potential confounder variables including gestational age at enrollment and delivery, maternal body mass index, gestational weight gain, type of delivery, treatment modality, and GDM diagnosis in the first trimester.ConclusionWe found that although the rates of GDM more than doubled with the One-step strategy, the One-step approach was similar to the Two-step approach in terms of maternal and neonatal outcomes. These findings may warn that more caution should be exercised in adopting the One-step method worldwide. Future research is needed to assess the long-term harm and benefits of those approaches to GDM screening for both mothers and their offspring.Clinical trial registrationhttps://www.irct.ir/trial/518, identifier (IRCT138707081281N1).

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One-Step Compared With Two-Step Gestational Diabetes Screening and Pregnancy Outcomes

Abstract: There is no difference in rates of large-for-gestational-age neonates with a one-step testing strategy compared with a two-step testing strategy for gestational diabetes mellitus.

Cited by 13 publications

References 33 publications

Recent trials comparing definitions of gestational diabetes: a need to step back

Recent trials comparing definitions of gestational diabetes: a need to step back

The effect of changing screening practices and demographics on the incidence of gestational diabetes in British Columbia, 2005–2019

One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial

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