The identification and treatment of women with hyperglycaemia in pregnancy: an analysis of individual participant data, systematic reviews, meta-analyses and an economic evaluation

Abstract

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Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: A systematic review and meta-analysis and analysis of two pregnancy cohorts

“…Recommendations regarding the identification of GDM vary and some institutions that previously recommended risk factor assessment now recommend offering all women an OGTT, however there is a lack of supporting evidence that this strategy improves maternal and offspring health compared to selective testing high risk women [8] and given the likely increase in associated costs, clinicians and commissioners may not be willing or able to accept universal testing for GDM. The risk factors that we were able to assess in published studies were limited by what was available, but they included a range of the commonly used risk factors for GDM.…”

“…Treatment of GDM improves perinatal outcomes,[6–8] suggesting a role for identifying women with GDM. There is uncertainty about the effectiveness of different strategies for identifying these women, largely because of the lack of good quality evidence.…”

“…There is uncertainty about the effectiveness of different strategies for identifying these women, largely because of the lack of good quality evidence. [8,9] This has led to variation in clinical guidelines and practice for identifying GDM, both between and within countries. Strategies include selectively offering a 75g or 100g oral glucose tolerance test (OGTT) to high risk women only, identified using specific risk factors (usually easily identifiable maternal characteristics) or the administration of a 50g glucose challenge test.…”

“…GDM is also a risk factor for later development of type 2 diabetes,[3] if more women with GDM are identified, more could receive interventions aimed at reducing these risks and alongside lifelong screening to identify type 2 diabetes earlier, associated morbidities and costs may be reduced, however there is no robust evidence of longer-term benefit from the identification of GDM using a universal testing strategy. [8]…”

Early diabetes screening in pregnancy

“…[1][2][3] With increasing rates of obesity and advanced maternal age, the prevalence of undiagnosed type 2 diabetes in nonpregnant women of childbearing age is growing, making this differentiation even more pertinent. 4,5 Traditionally, screening for GDM is performed at 24-28 weeks of pregnancy, a period characterized by increased physiologic insulin resistance. In 2010, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) published a consensus statement 2 for a strategy to diagnose GDM based on the glucose thresholds on a 75-g oral glucose tolerance test (OGTT) that conveys an odds ratio of 1.75 or more for adverse outcomes (fasting plasma glucose [FPG] 5.1−6.9 mmol/L, 1-hour post 75-g oral glucose load ≥10 mmol/L, or 2-hour post 75-g oral glucose load 8.5-11.0 mmol/L 1 ).…”