Screening for gestational diabetes

A systematic review and meta-analysis

Gabriela J. Prutsky, Juan Pablo Domecq, Vishnu Sundaresh, Tarig Elraiyah, Mohammed Nabhan, Larry J. Prokop, Adrian Vella, Victor Manuel Montori, Mohammad H Murad

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)4311-4318
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume98
Issue number11
DOIs
StatePublished - Nov 1 2013

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Gestational Diabetes
Medical problems
Meta-Analysis
Screening
Odds Ratio
Confidence Intervals
Pregnancy Induced Hypertension
Randomized Controlled Trials
Library Science
Mothers
Pregnancy
Information Storage and Retrieval
Hyperglycemia
Observational Studies
Pregnant Women
Glucose

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Prutsky, G. J., Domecq, J. P., Sundaresh, V., Elraiyah, T., Nabhan, M., Prokop, L. J., ... Murad, M. H. (2013). Screening for gestational diabetes: A systematic review and meta-analysis. Journal of Clinical Endocrinology and Metabolism, 98(11), 4311-4318. https://doi.org/10.1210/jc.2013-2460

Screening for gestational diabetes : A systematic review and meta-analysis. / Prutsky, Gabriela J.; Domecq, Juan Pablo; Sundaresh, Vishnu; Elraiyah, Tarig; Nabhan, Mohammed; Prokop, Larry J.; Vella, Adrian; Montori, Victor Manuel; Murad, Mohammad H.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 98, No. 11, 01.11.2013, p. 4311-4318.

Research output: Contribution to journalArticle

Prutsky GJ, Domecq JP, Sundaresh V, Elraiyah T, Nabhan M, Prokop LJ et al. Screening for gestational diabetes: A systematic review and meta-analysis. Journal of Clinical Endocrinology and Metabolism. 2013 Nov 1;98(11):4311-4318. https://doi.org/10.1210/jc.2013-2460
Prutsky, Gabriela J. ; Domecq, Juan Pablo ; Sundaresh, Vishnu ; Elraiyah, Tarig ; Nabhan, Mohammed ; Prokop, Larry J. ; Vella, Adrian ; Montori, Victor Manuel ; Murad, Mohammad H. / Screening for gestational diabetes : A systematic review and meta-analysis. In: Journal of Clinical Endocrinology and Metabolism. 2013 ; Vol. 98, No. 11. pp. 4311-4318.
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abstract = "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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