TY - JOUR
T1 - Screening for gestational diabetes
T2 - A systematic review and meta-analysis
AU - Prutsky, Gabriela J.
AU - Domecq, Juan Pablo
AU - Sundaresh, Vishnu
AU - Elraiyah, Tarig
AU - Nabhan, Mohammed
AU - Prokop, Larry J.
AU - Vella, Adrian
AU - Montori, Victor M.
AU - Murad, Mohammad Hassan
N1 - Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2013/11/1
Y1 - 2013/11/1
N2 - Context: Gestational diabetes mellitus (GDM) is defined as any degree of hyperglycemia with first recognition during pregnancy. The optimal time to screen forGDMthat would maximize the yield and benefits remains unclear. Objective: Our objective was to appraise the evidence regarding screening for GDM (accuracy, correlation with adverse outcomes, and harms). Data Sources: We searched Ovid Medline, OVID EMBASE, OVID Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL through May 2011. Study Selection:Weincluded randomized controlled trials and observational studies that enrolled pregnant woman who were evaluated using different GDM screening tests. Data extraction: Two reviewers working independently abstracted the data. Results: We did not find any randomized controlled trials of GDM screening that measured fetomaternal outcomes. A 1-hour 50-g glucose challenge test with a cutoff point at 140 mg/dL was the most commonly used screening method. The results of this test were statistically associated with feto-maternal outcomes (P < .001), even though only 11% of individuals with a positive test (according to Carpenter and Coustan criteria) developed GDM. Positive Carpenter and Coustan criteria were associated with macrosomia (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.9 -3.1, P<.001) and gestational hypertension (OR=1.7, CI=1.3-2.1, P<.001). Positive National Diabetes Data Group criteria were also associated with macrosomia (OR = 3.2, CI = 2.3- 4.4, P < .001) and gestational hypertension (OR = 2.1, CI = 1.6 -2.8, P < .001). Conclusions: Indirect evidence supports the use of contemporary screening tests for GDM to identify pregnancies at increased risk of adverse feto-maternal outcomes. It also suggests that use of these tests will place somewomenunder unnecessary treatment for GDM.
AB - Context: Gestational diabetes mellitus (GDM) is defined as any degree of hyperglycemia with first recognition during pregnancy. The optimal time to screen forGDMthat would maximize the yield and benefits remains unclear. Objective: Our objective was to appraise the evidence regarding screening for GDM (accuracy, correlation with adverse outcomes, and harms). Data Sources: We searched Ovid Medline, OVID EMBASE, OVID Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL through May 2011. Study Selection:Weincluded randomized controlled trials and observational studies that enrolled pregnant woman who were evaluated using different GDM screening tests. Data extraction: Two reviewers working independently abstracted the data. Results: We did not find any randomized controlled trials of GDM screening that measured fetomaternal outcomes. A 1-hour 50-g glucose challenge test with a cutoff point at 140 mg/dL was the most commonly used screening method. The results of this test were statistically associated with feto-maternal outcomes (P < .001), even though only 11% of individuals with a positive test (according to Carpenter and Coustan criteria) developed GDM. Positive Carpenter and Coustan criteria were associated with macrosomia (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.9 -3.1, P<.001) and gestational hypertension (OR=1.7, CI=1.3-2.1, P<.001). Positive National Diabetes Data Group criteria were also associated with macrosomia (OR = 3.2, CI = 2.3- 4.4, P < .001) and gestational hypertension (OR = 2.1, CI = 1.6 -2.8, P < .001). Conclusions: Indirect evidence supports the use of contemporary screening tests for GDM to identify pregnancies at increased risk of adverse feto-maternal outcomes. It also suggests that use of these tests will place somewomenunder unnecessary treatment for GDM.
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U2 - 10.1210/jc.2013-2460
DO - 10.1210/jc.2013-2460
M3 - Review article
C2 - 24151288
AN - SCOPUS:84887441575
SN - 0021-972X
VL - 98
SP - 4311
EP - 4318
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 11
ER -