Trial compares two gestational diabetes screening strategies

0
401

According to results from a large-scale clinical study conducted by researchers at Kaiser Permanente and published in the New England Journal, there were no significant differences in health outcomes for pregnant women who had gestational diabetes or their babies using two different clinically recommended screening tests. Methods diagnosed were medicine.

While there is evidence that treating pregnant women for gestational diabetes results in improved health outcomes for mothers and their infants, there is no scientific consensus on how best to monitor gestational diabetes. In the US, two different approaches are recommended and used in clinical practice: a 1-step protocol that requires women to fast before testing (currently preferred by the American Diabetes Association) and a 2-step approach that requires no fasting is required the first test (currently recommended by the American College of Obstetricians and Gynecologists). This study was the first head-to-head study to compare maternal and perinatal outcomes from the two methods.

“We know that screening and diagnosing women with gestational diabetes improves outcomes for mothers and babies,” said senior author Teresa Hillier, MD, MS, researcher at Kaiser Permanente Northwest Center for Health Research and Kaiser Permanente Hawaii Center for Integrated Health Research . “Our study was designed to see if there were any differences in outcomes between the two approaches. The one-step method diagnoses twice as many women, which usually leads to treatment for women with milder gestational diabetes, but we found no evidence this higher diagnosis rate led to differences in the results. ”

The study included nearly 24,000 pregnant women from Kaiser Permanente, Hawaii and northwestern Portland, Oregon, all of whom were randomly assigned to the 1-step or 2-step testing protocol to screen for gestational diabetes as part of their clinical care . This head-to-head study design compared the results of the entire population in a “real” clinical setting, thus enabling generalizability for daily clinical practice. The women were enrolled between May 28, 2014 and December 31, 2017, and data on the results were collected between 2014 and 2018. The evaluated results included rates of diagnosis of gestational diabetes, gestational infants, gestational hypertension or preeclampsia, primary caesarean section, and a composite measure of several undesirable perinatal outcomes, including stillbirth and neonatal death.

The study found:

  • Among the 94% of women who completed screening, a greater proportion (92%) of women randomized to the 2-step protocol were adherent than those randomized to the 1-step approach ( 66%).
  • There was a significant difference in the diagnosis of gestational diabetes; 16.5% of women were diagnosed using the 1-step approach compared with 8.5% using the 2-step protocol.
  • There were no significant differences between the two gestational diabetes screening approaches in the primary
  • Rates were also similar between groups in a number of secondary and safety outcomes, including premature delivery and neonatal ICU admission.

“What this large-scale clinical study shows is that the 2-step method of screening appears to be preferred by patients and providers and has a lower screening positive rate and results that do not differ from the 1-step method. Differentiate method. “Explained Dr. Keith Ogasawara, Chief Perinatologist, Obstetrics and Gynecology Department at Kaiser Permanente in Hawaii.

###

The study was funded by the National Institute for Child Health and Human Development by Eunice Kennedy Shriver.

Other authors on the study are Kathryn Pedula, MS, Hawaii Permanente Medical Group, Honolulu; Kimberly K. Vesco, MD, MPH, Kaiser Permanente Center for Health Research, Portland, Oregon; Caryn ES Oshiro, PhD, Kaiser Permanente Center for Integrated Health Research, Honolulu; Dr. med. Suzanne Lubarsky, Northwest Permanente, Portland; and Jan Van Marter, MPA, RN, Kaiser Permanente Center for Health Research, Portland.

About Kaiser Permanente

Kaiser Permanente is committed to shaping the future of healthcare. We are recognized as one of America’s premier healthcare providers and nonprofit health plans. Established in 1945, Kaiser Permanente is dedicated to providing high quality, affordable health services and improving the health of our members and the communities we serve. We currently serve 12.4 million members in 8 states and the District of Columbia. The care of members and patients is focused on their overall health and is led by their personal doctors, specialists and the team of nurses of the Permanente Medical Group. Our knowledgeable and caring medical teams are backed and supported by industry-leading technological advances and tools for health promotion, disease prevention, cutting-edge care and world-class chronic disease management. Kaiser Permanente is dedicated to nursing innovation, clinical research, health education, and community health support.

Disclaimer: AAAS and EurekAlert! are not responsible for the correctness of the press releases published on EurekAlert! by contributing institutions or to use information through the EurekAlert system.