Perinatal Outcomes of Two Screening Strategies for Gestational Diabetes Mellitus

Davis, Esa M.; Abebe, Kaleab Z.; Simhan, Hyagriv N.; Catalano, Patrick M.; Costacou, Tina; Comer, Diane; Orris, Steven R.; Ly, Kathleen N.; Decker, Alison; Méndez, Dara D.; Day, Nancy L.; Scifres, Christina

doi:10.1097/aog.0000000000004431

Cited by 60 publications

(66 citation statements)

References 34 publications

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“…However, when using a two-step screening strategy with GCT, a 100g OGTT is only needed in about 20% of all pregnant women. In line with normal clinical practice, adverse events of the screening tests would therefore occur in only 4% of women using a two-step screening strategy with GCT compared to 13% in women undergoing the one-step IADPSG approach with OGTT (11). Women who preferred a GCT or two-step screening strategy had a better metabolic profile (were less often obese and less insulin resistant) and had less risk factors for GDM compared to women who preferred an OGTT or one-step screening approach.…”

Section: Discussionmentioning

confidence: 72%

“…Evidence is lacking that treatment of GDM based on the one-step IADPSG screening approach improves pregnancy outcomes compared to other screening strategies. Recently, two large RCT’s from the US showed that a one-step screening strategy with the IADPSG criteria leads to a 2-3 fold increase in GDM prevalence compared to screening with a two-step approach with GCT but without improvement of pregnancy outcomes ( 11 ). In addition, the OGTT is often considered a cumbersome test during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…This is in line with other studies reporting difficulties with an OGTT in pregnancy, in which vomiting is often a reason for failure of the test ( 30 ). A recent RCT from the US showed that a 75g OGTT was better tolerated than a 100g OGTT for the diagnosis of GDM ( 11 ). However, when using a two-step screening strategy with GCT, a 100g OGTT is only needed in about 20% of all pregnant women.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, many European countries still use selective screening for GDM based on risk factors or recommend a two-step screening strategy with a glucose challenge test (GCT) ( 10 ). In addition, evidence is lacking that treatment of GDM based on the IADPSG screening strategy improves pregnancy outcomes compared to other screening strategies ( 11 , 12 ). Moreover, a GCT is generally better tolerated than an OGTT and has the advantage that it can be performed in a non-fasting state ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Preference of Women for Gestational Diabetes Screening Method According to Tolerance of Tests and Population Characteristics

et al. 2021

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AimsTo determine the preferred method of screening for gestational diabetes mellitus (GDM).Methods1804 women from a prospective study (NCT02036619) received a glucose challenge test (GCT) and 75g oral glucose tolerance test (OGTT) between 24-28 weeks. Tolerance of screening tests and preference for screening strategy (two-step screening strategy with GCT compared to one-step screening strategy with OGTT) were evaluated by a self-designed questionnaire at the time of the GCT and OGTT.ResultsCompared to women who preferred one-step screening [26.2% (472)], women who preferred two-step screening [46.3% (834)] were less often from a minor ethnic background [6.0% (50) vs. 10.7% (50), p=0.003], had less often a previous history of GDM [7.3% (29) vs. 13.8% (32), p=0.008], were less often overweight or obese [respectively 23.1% (50) vs. 24.8% (116), p<0.001 and 7.9% (66) vs. 18.2% (85), p<0.001], were less insulin resistant in early pregnancy (HOMA-IR 8.9 (6.4-12.3) vs. 9.9 (7.2-14.2), p<0.001], and pregnancy outcomes were similar except for fewer labor inductions and emergency cesarean sections [respectively 26.6% (198) vs. 32.5% (137), p=0.031 and 8.2% (68) vs. 13.0% (61), p=0.005]. Women who preferred two-step screening had more often complaints of the OGTT compared to women who preferred one-step screening [50.4% (420) vs. 40.3% (190), p<0.001].ConclusionsA two-step GDM screening involving a GCT and subsequent OGTT is the preferred GDM screening strategy. Women with a more adverse metabolic profile preferred one-step screening with OGTT while women preferring two-step screening had a better metabolic profile and more discomfort of the OGTT. The preference for the GDM screening method is in line with the recommended Flemish modified two-step screening method, in which women at higher risk for GDM are recommended a one-step screening strategy with an OGTT, while women without these risk factors, are offered a two-step screening strategy with GCT.Clinical Trial RegistrationNCT02036619 https://clinicaltrials.gov/ct2/show/NCT02036619

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preference of Women for Gestational Diabetes Screening Method According to Tolerance of Tests and Population Characteristics

et al. 2021

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“…Therefore, many European countries still use selective screening for GDM based on risk factors or recommend a twostep screening strategy with a glucose challenge test (GCT) (10). In addition, evidence is lacking that treatment of GDM based on the IADPSG screening strategy improves pregnancy outcomes compared to other screening strategies (11,12). Moreover, a GCT is generally better tolerated than an OGTT and has the advantage that it can be performed in a non-fasting state (12).…”

Section: Introductionmentioning

confidence: 99%

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Screening for Gestational Diabetes

Pillay

Donovan

Guitard

et al. 2021

JAMA

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STUDY SELECTION English-language intervention studies for screening and treatment; observational studies on screening; prospective studies on screening test accuracy. DATA EXTRACTION AND SYNTHESISDual review of titles/abstracts, full-text articles, and study quality. Single-reviewer data abstraction with verification. Random-effects meta-analysis or bivariate analysis (accuracy).MAIN OUTCOMES AND MEASURES Pregnancy, fetal/neonatal, and long-term health outcomes; harms of screening; accuracy. RESULTS A total of 76 studies were included (18 randomized clinical trials [RCTs] [n = 31 241], 2 nonrandomized intervention studies [n = 190], 56 observational studies [n = 261 678]). Direct evidence on benefits of screening vs no screening was limited to 4 observational studies with inconsistent findings and methodological limitations. Screening was not significantly associated with serious or long-term harm. In 5 RCTs (n = 25 772), 1-step (International Association of Diabetes and Pregnancy Study Group) vs 2-step (Carpenter and Coustan) screening was significantly associated with increased likelihood of gestational diabetes (11.5% vs 4.9%) but no improved health outcomes. At or after 24 weeks of gestation, oral glucose challenge tests with 140-and 135-mg/dL cutoffs had sensitivities of 82% and 93%, respectively, and specificities of 82% and 79%, respectively, against Carpenter and Coustan criteria, and a test with a 140-mg/dL cutoff had sensitivity of 85% and specificity of 81% against the National Diabetes Group Data criteria. Fasting plasma glucose tests with cutoffs of 85 and 90 mg/dL had sensitivities of 88% and 81% and specificities of 73% and 82%, respectively, against Carpenter and Coustan criteria. Based on 8 RCTs and 1 nonrandomized study (n = 3982), treatment was significantly associated with decreased risk of primary cesarean deliveries (relative risk [RR]

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Perinatal Outcomes of Two Screening Strategies for Gestational Diabetes Mellitus

Abstract: et al. Perinatal outcomes of two screening strategies for gestational diabetes mellitus: a randomized controlled trial. Obstet Gynecol 2021;138. The authors provided this information as a supplement to their article.

Cited by 60 publications

References 34 publications

Preference of Women for Gestational Diabetes Screening Method According to Tolerance of Tests and Population Characteristics

Preference of Women for Gestational Diabetes Screening Method According to Tolerance of Tests and Population Characteristics

DataSheet_1.docx

Screening for Gestational Diabetes

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