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First trimester gestational diabetes screening - Change in incidence and pharmacotherapy need

Marisa L Alunni1, Hilary A Roeder1, Thomas R Moore1

  • 1UC San Diego Health System, Department of Reproductive Medicine, Division of Perinatology, 200 West Arbor Drive - MC 8433, San Diego, CA 92103, United States.

Diabetes Research and Clinical Practice
|May 11, 2015
PubMed

Insights

Early gestational diabetes (GDM) screening nearly doubled diagnosis rates. While early screening increased pharmacotherapy needs, body mass index (BMI) was the key predictor, with no impact on neonatal outcomes.

Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Perinatal Medicine

Background:

  • Gestational diabetes mellitus (GDM) diagnosis and management are critical for maternal and infant health.
  • Current screening protocols vary, impacting diagnosis rates and subsequent treatment needs.
  • The International Association of Diabetes in Pregnancy Study Groups (IADPSG) and California Diabetes and Pregnancy Program recommend specific screening guidelines.

Purpose of the Study:

  • To compare gestational diabetes mellitus (GDM) diagnosis rates between standard two-step screening and early screening methods.
  • To evaluate differences in pharmacotherapy requirements for GDM diagnosed via early versus standard screening.
  • To assess the impact of early GDM screening on perinatal outcomes.

Main Methods:

  • Retrospective study of singleton pregnancies between July 2010 and June 2012.
  • Comparison of two cohorts: standard two-step screening versus early screening (HbA1c ≥5.7% or fasting plasma glucose (FPG) ≥92 mg/dL at ≤24 weeks, or 2-h oral glucose tolerance test (GTT) between 24-28 weeks).
  • Analysis included GDM diagnosis rates, pharmacotherapy needs, and neonatal outcomes (birth weight, macrosomia).

Main Results:

  • Early screening diagnosed GDM in 9.4% of patients, compared to 5.3% with two-step screening.
  • Pharmacotherapy was required in 49.2% (HbA1c), 66.7% (FPG), and 78.9% (HbA1c and FPG) of early-screened GDM cases, versus 30.6% for those diagnosed via 2-h GTT (p<0.001).
  • Body mass index (BMI) was the strongest predictor of pharmacotherapy need (aOR 1.13). No significant differences were observed in mean birth weight or macrosomia rates between the groups.

Conclusions:

  • Implementing early GDM screening significantly increases diagnosis rates.
  • Early screening is associated with higher pharmacotherapy requirements, with BMI being a key predictive factor.
  • Early GDM screening did not adversely affect neonatal outcomes such as birth weight or macrosomia.
Abstract

Keywords:
Early screeningGestational diabetesIncidenceOutcomePharmacotherapy

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