March 10, 2021
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A one-step screening strategy for gestational diabetes resulted in nearly twice as many diagnoses as a two-step strategy, according to a study published in the New England Journal of Medicine.
However, researchers said there were no significant differences in complications between mothers or infants using the one-step versus the two-step strategy.
Reference: Hillier TA, et al. N Engl J Med. 2021; doi: 10.1056 / NEJMoa2026028.
“Universal gestational diabetes screening is recommended between the 24th and 28th week of pregnancy because data from randomized controlled trials show that treating gestational diabetes improves outcomes in both maternal and perinatal patients.” Teresa A. Hillier, MD, Distinguished Investigator of the Center for Health Research at Kaiser Permanente Northwest and colleagues wrote. “There is no scientific consensus on how best to diagnose gestational diabetes.”
Hillier and colleagues compared results in women who received gestational diabetes screening using the one-step approach of the International Association of Diabetes and Pregnancy Study Groups and the two-step approach of the American College of Obstetricians and Gynecologists.
In the one-step approach, patients are given a 2-hour oral glucose tolerance test and are required to fast before the visit. In the two-step screening strategy, patients are given a 1-hour glucose challenge test and patients with high blood glucose levels are re-given a 3-hour diagnostic oral glucose tolerance test.
Hillier and colleagues evaluated the results of all pregnant women who presented for treatment from May 28, 2014 at Kaiser Permanente Northwest, Oregon and June 3, 2014 at Kaiser Permanente Hawaii through December 2017. Participants were randomly given either one-step or two-step screening for gestational diabetes.
Researchers evaluated 23,792 pregnant women, with 66% of women receiving one-step screening and 92% receiving two-step screening.
Hillier and colleagues found that 16.5% of women in the one-step group and 8.5% of women in the two-step group were diagnosed with gestational diabetes (unadjusted relative risk) [RR] = 1.94; 97.5% CI, 1.79-2.11).
In their intention-to-treat analyzes, the researchers found that the incidence for infants of advanced gestational age was 8.9% in the one-step group and 9.2% in the two-step group (RR = 0 , 95; 97.5% CI, 0.87-1.05); The incidence of perinatal composite outcomes was 3.1% in the one-step group and 3% in the two-step group (RR = 1.04; 97.5% CI, 0.88 to 1.23).
They also found that the incidence of gestational hypertension or preeclampsia was 13.6% in the one-step group and 13.5% in the two-step group (RR = 1; 97.5% CI, 0.93 -1.08) and the incidence of primary caesarean section was 24% in the one-step group and 24.6% in the two-step group (RR = 0.98; 97.5% CI, 0.93- 1.02).
According to the researchers, the results were similar in analyzes that took into account differences in compliance between the one-step and two-step groups.
“In our large, randomized study, one-step screening doubled the incidence of gestational diabetes diagnosis compared to two-step screening, but had no impact on the risk of gestational infants and undesirable perinatal outcomes. primary caesarean section or gestational hypertension or preeclampsia, ”wrote Hillier and colleagues.
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