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One-step versus two-step diagnostic testing for gestational diabetes: a randomized controlled trial.

Adeeb Khalifeh1,2, Rebecca Eckler2, Laura Felder2

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The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|July 10, 2018
PubMed
Summary

The one-step screening approach for gestational diabetes mellitus (GDM) showed a similar incidence of GDM compared to the two-step method. This study found no significant differences in GDM rates between the two screening strategies.

Keywords:
Diabetes mellitusdiethyperglycemiaobesestillbirth

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Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Clinical Trials

Background:

  • Gestational diabetes mellitus (GDM) is a significant complication of pregnancy.
  • Current screening guidelines vary, with one-step and two-step approaches being commonly used.
  • Evaluating the comparative effectiveness of these screening methods is crucial for optimizing maternal and fetal care.

Purpose of the Study:

  • To compare the incidence of gestational diabetes mellitus (GDM) using the one-step versus the two-step screening approach.
  • To assess secondary outcomes including preeclampsia, preterm birth, and mode of delivery.

Main Methods:

  • A parallel group, nonblinded randomized trial was conducted with pregnant women eligible for GDM screening.
  • Participants were randomized 1:1 to either the one-step (75-g, 2-h oral glucose tolerance test) or the two-step (50-g, 1-h screen followed by 100-g, 3-h oral glucose tolerance test if indicated) approach.
  • The primary outcome was the incidence of GDM, with intention-to-treat analysis.

Main Results:

  • A total of 249 women completed the screening (123 in the one-step group, 126 in the two-step group).
  • GDM incidence was 8.1% in the one-step group and 5.6% in the two-step group (p=0.42), showing no significant difference.
  • Secondary outcomes, including preeclampsia, preterm birth, and mode of delivery, were also similar between the groups.

Conclusions:

  • The one-step screening approach for GDM results in a similar incidence of the condition compared to the two-step approach.
  • No significant differences were observed in key maternal and perinatal outcomes between the two screening methods.
  • These findings support the use of either screening strategy regarding GDM incidence and associated complications.