Systematic review and meta-analysis of diagnosing gestational diabetes mellitus with one-step or two-step approaches and associations with adverse pregnancy outcomes.

Abstract

There is an ongoing discussion about the optimal diagnostic strategy for gestational diabetes mellitus (GDM). To assess the magnitude of the association between GDM diagnosed with the one-step (International Association of Diabetes and Pregnancy Study Groups criteria) or two-step (Carpenter and Coustan criteria) approach and selected adverse pregnancy outcomes. Five electronic databases were searched up to October 2017 using Medical Subject Headings for each adverse outcome combined with the term "gestational diabetes." Observational studies assessing the one-step versus the two-step diagnostic approach in GDM. Relative risks were extracted and random-effects models were used to estimate pooled relative risks (RRs). A total of 41663 participants from nine studies were included. Gestational diabetes mellitus was significantly associated with pre-eclampsia (RR 1.68 vs RR 1.77), cesarean delivery (RR 1.28 vs RR 1.33), and large for gestational age (RR 1.44 vs RR 1.68) when diagnosed with the one-step versus the two-step approach. A one-step diagnosis also increased the risks of neonatal intensive care unit admission and gestational hypertension, whereas a two-step diagnosis increased the incidence of macrosomia. Women with GDM diagnosed with either the one-step or the two-step approach were at increased risk for selected adverse pregnancy outcomes. The associations with the two-step method were slightly stronger.