Comparison of One-Step Versus Two-Step Screening for Diagnosis of GDM in Indian Population: A Randomized Controlled Trial.

Abstract

To compare the incidence, maternal and fetal outcomes of gestational diabetes mellitus using one step versus two steps as a screening procedure. A prospective randomized trial involving screening of 1000 pregnant women for gestational diabetes mellitus was conducted. Women were divided in two groups (500 each). Group A comprised of patients screened with two-step approach (ACOG recommendation), and group B comprised of women screened by one-step method (IADPSG criteria). Women diagnosed with 'gestational diabetes' were followed in an antenatal clinic, and incidence of GDM and maternal and fetal outcome between two groups were analyzed using SPSS. The incidence of GDM was almost double using one-step versus two-step approach which was 19.2 and 11.8%, respectively. Maternal outcomes were comparable in both the groups except the risk of preterm delivery which was 2.5 times more in group A than group B (odds ratio=2.43 95% CI 1.01-5.79). Further, fetal outcomes were also comparable except neonatal hypoglycemia which was seen in 29.31% in group A versus 7.4% in group B. In the group B, 15 patients (15.8%) with GDM (based on FBS≥92mg/dl at first ANC visit) showed clinical symptoms and blood sugars in hypoglycemic range on MNT requiring resumption of normal diet. The incidence of GDM using IADPSG criteria was almost double versus ACOG criteria. Maternal and fetal outcomes were comparable except in 15.8% women diagnosed as GDM (using FBS≥92mg/dl at first ANC visit as per IADPSG) and suffered from hypoglycemia. A large trial is being proposed before these criteria are adopted.