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Screening for Gestational Diabetes: Updated Evidence Report and Systematic Review for the US Preventive Services Task
Jennifer Pillay1, Lois Donovan2, Samantha Guitard1
1University of Alberta Evidence-based Practice Center, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
JAMA
|August 10, 2021
Summary
Screening for gestational diabetes mellitus (GDM) shows limited direct evidence of benefit. However, treatment of GDM after 24 weeks of gestation significantly improves maternal and neonatal health outcomes.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Public Health
Background:
- Gestational diabetes mellitus (GDM) is linked to adverse maternal and fetal health outcomes.
- The US Preventive Services Task Force (USPSTF) requires updated evidence on GDM screening and treatment.
Purpose of the Study:
- To review the evidence on screening for GDM and its impact on health outcomes.
- To evaluate the accuracy and effectiveness of different GDM screening tests and treatment protocols.
Main Methods:
- Systematic review of randomized clinical trials (RCTs), nonrandomized intervention studies, and observational studies.
- Meta-analysis and bivariate analysis were used to synthesize data on screening accuracy and treatment efficacy.
- Studies published between 2010 and 2020 were included, with surveillance through June 2021.
Main Results:
- Limited direct evidence supports the benefits of GDM screening versus no screening.
- One-step screening methods were associated with higher GDM diagnosis rates but not improved health outcomes compared to two-step methods.
- GDM treatment initiated at or after 24 weeks of gestation significantly reduced risks of primary cesarean delivery, shoulder dystocia, macrosomia, and neonatal intensive care unit admissions.
Conclusions:
- Current evidence on the benefits of GDM screening is limited and inconsistent.
- GDM treatment is associated with significant improvements in key maternal and neonatal health outcomes.
- Further research is needed to clarify the optimal screening strategies for GDM.
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