Early Screening For Gestational Diabetes Research Articles

Pregnancy outcomes and early screening for gestational diabetes among high-risk patients based on ACOG’s criteria

Currently there are no published randomized control trials on early screening for gestational diabetes (GDM) in high-risk patients based on the American College of Obstetricians and Gynecologists (ACOG) criteria. We aim to evaluate whether early screening for GDM in patients deemed high-risk based on ACOG criteria lead to improved pregnancy outcomes.

Early Gestational Diabetes Screening Based on ACOG Guidelines.

A recent randomized controlled trial suggested that early gestational diabetes mellitus (GDM) screening in patients with obesity (body mass index [BMI] ≥30 kg/m2) does not improve perinatal outcomes. The American College of Obstetrics and Gynecology currently recommends early screening for gestational diabetes in patients who are overweight with one or more additional risk factors. We evaluated the effect of screening based on the number of additional risk factors for development of gestational diabetes. This was a secondary analysis of a multicenter randomized controlled trial of obese patients with singleton nonanomalous fetuses comparing early (14-20 weeks' gestation) with routine (24-28 weeks' gestation) GDM screening. Exclusion criteria were pregestational diabetes, major medical illnesses, bariatric surgery, chronic steroid use, and prior cesarean. Early versus routine GDM screening groups were compared and stratified by the number of additional risk factors for GDM (0, 1, 2, and ≥3). The primary outcome was an adverse perinatal composite outcome composed of: macrosomia, primary cesarean delivery, hypertensive disorders of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia. Analyses examined effects of early versus routine screening by the number of additional risk factors and their possible interaction on the incidences of the primary outcome and GDM. Of 913 patients, 5% had 0, 52% had 1, 33% had 2, and 10% had ≥3 additional risk factors. Baseline characteristics, including the number and type of risk factors, were similar between early and routine screening groups. Breslow-Day test for interaction between early versus routine screening and the number of additional risk factors was not significant for either the primary outcome (p = 0.37) or the diagnosis of GDM (p = 0.28). The incidence of GDM and the adverse perinatal composite outcome increased as the number of risk factors increased (p < 0.001). In patients with BMI ≥30 kg/m2 and additional risk factors, early GDM screening does not prevent adverse outcomes. · The ACOG currently recommends early screening for gestational diabetes if patients have risk factors.. · Even in patients with multiple risk factors, early screening for GDM does not improve outcomes.. · Patients with three or more risk factors may have worse outcomes if they undergo early screening..

How clinicians can support women in making decisions about psychopharmacological treatments in pregnancy

How clinicians can support women in making decisions about psychopharmacological treatments in pregnancy

Early gestational diabetes screening in women at risk for gestational diabetes: a randomized controlled trial

Early gestational diabetes screening in women at risk for gestational diabetes: a randomized controlled trial

Potential role of biochemical placentation markers - pregnancy associated plasma protein-A and human chorionic gonadotropin for early gestational diabetes screening - a pilot study.

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. The universal screening for GDM is usually performed between 24-28 weeks' gestation. This often delays the diagnosis and could increase the risk of adverse pregnancy outcomes. Some of the biochemical placental markers - pregnancy associated plasma protein A (PAPP-A) and free-β human chorionic gonadotropin (hCG), probably could provide a diagnostic value for GDM. The aim of our study was to assess if PAPP-A and hCG values were different among pregnant women with and without GDM and respectively, to tested their place in the early GDM screening. We conducted a retrospective, case-control study by reviewing the clinical database records of 662 pregnant women. The analysis includes the data for a two-year period. The patients included in the observation were divided into two groups - GDM group (n = 412) and Euglycemic group (n = 250). Early screening for GDМ between 9-12 weeks' gestation was performed in 173 of the women in the interventional group due to: registered fasting plasma glucose (FPG) above 5.1 mmol/L, obesity, macrosomia in previous pregnancies or family history for diabetes mellitus. The remaining 239 women underwent universal screening at 24-28 weeks' gestation. Mean serum levels of PAPP-A, hCG, FPG, and body mass index (BMI) were measured between 10-13 gestational weeks. Serum levels of PAPP-A and hCG are presented as multiples of the normal median (MoM), adjusted by maternal baseline characteristics and demographics. In patients who developed GDM during pregnancy, compared with the control group, we have found significantly lower MoM values of PAPP-A (p < 0.0001), higher levels of FPG (р < 0.0001) and higher BMI (р < 0.0001). Median hCG MoM was similar in both group of pregnant women. Our findings suggest that low-normal to low reference range values of PAPP-A might be associated with higher risk for GDM. PAAP-A levels can be used as an additional factor to recommend early screening for GDM.

Early Screening for Gestational Diabetes Using IADPSG Criteria May Be a Useful Predictor for Congenital Anomalies: Preliminary Data from a High-Risk Population.

Background: Our aim was to investigate whether the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) glycemic thresholds used for detecting hyperglycemia in pregnancy can be predictive for malformations in women with hyperglycemia detected in early pregnancy. Methods: a single-center, retrospective observational trial of 125 mother-infant pairs from singleton pregnancies with hyperglycemia according to the IADPSG criteria diagnosed at the gestational age below 16 weeks. Glucose values obtained from 75-g OGTT (oral glucose tolerance test) were investigated as predictors for congenital malformations in newborns. Results: Characteristics of the cohort: maternal age: 31.5 ± 5.2, pre-pregnancy body mass index (BMI) ≥ 30 kg/m2: 42.0%, gestational age at diagnosis (weeks): 12.0 ± 4.0, and newborns with congenital malformations: 8.8%. Fasting blood glycemia (FBG) and HbA1c (Haemoglobin A1c) at baseline significantly predicted the outcome (expB: 1.06 (1.02–1.1), p = 0.007 and expB: 2.05 (1.24–3.38), p = 0.005, respectively). Both the fasting blood glucose (FBG) value of 5.1 mmol/dL (diagnostic for gestational diabetes mellitus (GDM)) and 5.5 mmol/dL (upper limit for normoglycemia in the general population) significantly increased the likelihood ratio (LR) for fetal malformations: 1.3 (1.1; 1.4) and 1.5 (1.0; 2.4), respectively. Conclusions: (1) Fasting glycemia diagnostic for GDM measured in early pregnancy is associated with a significantly elevated risk for congenital malformations. (2) Our data suggest that women at elevated risks of GDM/diabetes in pregnancy (DiP) should have their fasting blood glucose assessed before becoming pregnant, and the optimization of glycemic control should be considered if the FBG exceeds 5.1 mmol/dL.

Early gestational diabetes screening in obese women: a randomized controlled trial

Although in 2013 the American College of Obstetricians and Gynecologists recommended early screening for gestational diabetes in obese women, no studies demonstrate an improvement in perinatal outcomes with this strategy. We sought to determine whether early screening for gestational diabetes improves perinatal outcomes in obese women. Randomized controlled trial comparing early gestational diabetes screening (14-20 weeks) to routine screening (24-28 weeks) in obese women (body mass index ≥30 kg/m2) at 2 tertiary care centers in the United States. Screening was performed using a 50-g, 1-hour glucose challenge test followedby a 100-g, 3-hour glucose tolerance test if the initial screen was ≥135 mg/dL. Gestational diabetes was diagnosed usingCarpenter-Coustan criteria. Women not diagnosed at 14 to 20weeks were rescreened at 24 to 28 weeks. Exclusion criteria werepre-existing diabetes, major medical illness, bariatric surgery, andprior cesarean delivery. The primary outcome was a compositeofmacrosomia (>4000 g), primary cesarean delivery, hypertensive disease of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia (assessed within 48 hours of birth). A total of 962 women were randomized, and outcomes were available for 922. Of these 922 women, 459 (49.8%) were assigned to early screen and 463 (50.2%) to routine screen. Baseline characteristics were balanced between groups. In the early screening group, 69 (15.0%; 95% confidence interval, 11.9-18.6%) were diagnosed with gestational diabetes: 29 (6.3%; 95% confidence interval, 4.3-8.9%) at <20 weeks and 40 (8.7%; 95% confidence interval, 6.3-11.7%) at >24 weeks. Of those randomized to routine screening, 56 (12.1%; 95% confidence interval, 9.3-15.4%) had gestational diabetes. Early screening did not reduce the incidence of the primary outcome (56.9% in the early screen versus 50.8% in the routine screen, P= .07; relative risk, 1.12; 95% confidence interval, 0.99-1.26). Early screening for gestational diabetes in obese women did not reduce the composite perinatal outcome.

440: Early gestational diabetes screening in class III obesity (BMI≥40)

A recent randomized controlled trial suggested that early gestational diabetes (GDM) screening (14-20wks) in women with obesity (defined as BMI ≥30) does not improve GDM-related outcomes. However, ACOG recommends that obese women without other risk factors be screened only if BMI ³40 kg/m2. We aim to evaluate whether early screening for GDM improves pregnancy outcomes in patients with BMI ≥40. This was a secondary analysis of a randomized controlled trial performed at the University of Alabama at Birmingham of obese women with singleton non-anomalous gestations comparing early GDM screening (14-20wga) to routine (24-28wga). Women were included in this analysis if BMI≥40 kg/m2. Exclusion criteria were pregestational diabetes, major medical illnesses (cardiac, hemoglobinopathy, prednisone), bariatric surgery, and prior cesarean. An intention to treat analysis was performed with patient characteristics and outcomes compared by randomization group. Chi squared test of association was performed for categorical measures with relative risks calculated for outcomes. Student T-test and Wilcoxon rank sum test were used to compare continuous variables. Primary outcome was a composite primary cesarean, macrosomia (>4000g), pregnancy-induced hypertension, neonatal hypoglycemia (< 40 mg/dL), or neonatal hyperbilirubinemia. Secondary outcome was a composite in patients diagnosed with GDM (Table 2). Of 954 women in the original study, 218 (23%) women were included for analysis. 111 were randomized to early screening and 107 were randomized to routine screening. Baseline characteristics (age, race, BMI, insurance status, and parity) across groups were similar. Early screening did not reduce the incidence of the primary outcome (Table 1). Of the women who were diagnosed with GDM, there was no change in primary composite (Table 2). In women with BMI ≥40 kg/m2, early GDM screening is not beneficial. Recommendations for early GDM screening in this population should continue to be evaluated.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

427: When should early screening for gestational diabetes occur?

While ACOG and ADA recommend early screening for gestational diabetes (GDM) in overweight women with additional risk factors, the timing of “early” is poorly defined. We sought to define the optimal timing of early screening by comparing testing results and outcomes by the gestational age at screening. Secondary analysis of a multicenter randomized controlled trial of obese women with singleton non-anomalous gestations comparing early to routine screening for GDM. Women were excluded for pregestational diabetes, major medical illness, bariatric surgery, or primary cesarean. All screening was accomplished with the two-step method: women with 1-hr glucose challenge test (GCT) ≥135 mg/dL underwent a 3-hr test with Carpenter-Coustan criteria for diagnosis. For this per protocol analysis, early screening was stratified into two-week blocks (14-15.9, 16-17.9, 18-18.9, and 20-21.9). Value of the GCT, proportion with GCT≥135 mg/dL, proportion with GDM, and incidence of the primary composite outcome (primary cesarean, macrosomia [>4000g], pregnancy induced hypertension, shoulder dystocia, hyperbilirubinemia, and hypoglycemia) were compared across strata. The composite outcome was compared between each early stratum and the routine screen group. Groups were compared with a chi-squared, chi-squared for trend, or Student’s t-test as appropriate. Of 857 women, 390 (45.5%) received screening between 14-21.9 weeks. Strata were similar in age, race, BMI, and HbA1c. Women screened earlier were more likely to have hypertension (p=0.03). GCT value, GDM diagnosis < 24 weeks, and gestational age at diagnosis of GDM did not change by timing of early screen (Table 1). Incidence of the primary outcome did not change by timing of early screen. No timing of early screening was associated with a decrease in the primary composite outcome compared to routine screening (Figure 1). Between 14-21.9 weeks, timing of early GDM screen did not impact screening and diagnosis values, nor did it impact the effect of treatment at current screening and diagnosis thresholds.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

71: Early gestational diabetes screening based on ACOG guidelines

A recent randomized controlled trial suggested that early gestational diabetes (GDM) screening in women with obesity (BMI≥30) does not improve outcomes. ACOG currently recommends early screening for gestational diabetes in women who are obese with one or more additional risk factors (Table 1). We evaluate whether early screening in patients with additional risk factors improves pregnancy outcomes. This was a secondary analysis of a multi-center randomized controlled trial of obese women with singleton non-anomalous gestations comparing early GDM screening (14-20wga) to routine (24-28wga). Exclusion criteria were pregestational diabetes, major medical illnesses, bariatric surgery, and prior cesarean. Primary outcome was an adverse perinatal composite outcome composite (Table 1). Randomization groups were compared, stratified by the number of additional risk factors for GDM (0, 1, 2, ≥3). Chi squared test of association was performed for categorical measures with relative risks calculated for outcomes. Breslow-Day test was used to test interaction between randomization group and gestational age at the time of GDM screen. Secondary outcome was incidence of the primary outcome and GDM by number of additional risk factors (chi-squared test for trend). Of 913 women, 5% had 0, 52% had 1, 33% had 2, and 10% had ≥3 additional risk factors. Baseline characteristics, including number and type of risk factors, were similar between early and routine screening groups. Early screening (compared to routine screening) was not associated with a reduction in the adverse perinatal composite regardless of number of additional risk factors present (Table 1), although the incidence of GDM and the adverse perinatal composite outcome increased as the number of risk factors increased (Table 2, p< 0.001). Breslow-Day test for interaction was not significant for either the primary outcome (p=0.37) or GDM (p=0.28). In women with BMI≥30 and additional risk factors, early GDM screening is not beneficial. Recommendations for early GDM screening in this population should continue to be evaluated.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Establishing New Diagnostic Criteria for Early Gestational Diabetes Screening [30N

Establishing New Diagnostic Criteria for Early Gestational Diabetes Screening [30N

Establishing a Lower Cutoff Value for Early Gestational Diabetes Screening [6K

INTRODUCTION: Women who are not diagnosed with gestational diabetes mellitus (GDM) on early screening prior to 20 weeks go on to complete routine screening at 24-28 weeks. The aim of this study was to establish a low cutoff value for the early one-hour, 50-g glucose test (Glucola) under which no subsequent testing would be necessary. METHODS: This was an IRB-approved retrospective cohort study whereby electronic medical records in the Geisinger system between 1/1/2010 and 12/31/2016 were searched for all women who had an early Glucola and completed all subsequent indicated testing for GDM. For women with a result on the early Glucola less than 130 mg/dL, the risk of developing GDM for a given value was examined to identify a level below which further testing for GDM in the pregnancy may not be necessary. The primary outcome was percentage of women diagnosed with GDM at any point in the pregnancy for a given result on the early Glucola. RESULTS: There were 3040 women identified as having completed an early Glucola and 2405 women had a result less than 130 mg/dL. 174 of these women were subsequently diagnosed with GDM at some point in the pregnancy. The negative predictive value (NPV) for not developing GDM was greater than 90% for any one-hour glucose result less than 130 mg/dl. A result less than 114 mg/dL was shown to have a 95% NPV for not developing GDM. CONCLUSION: Forgoing routine screening in women with an early one-hour Glucola result below 114 mg/dL may be a viable option.

400: Early Screening for Gestational Diabetes: What cutoffs should we use?

400: Early Screening for Gestational Diabetes: What cutoffs should we use?

6: Early gestational diabetes screening in obese women: a randomized controlled trial

Although ACOG recommends screening obese women early for gestational diabetes (GDM), no studies demonstrate an improvement in perinatal outcomes. We sought to determine whether early GDM screening improves pregnancy outcomes in obese women. RCT of obese women (BMI≥30 kg/m2) with non-anomalous, singleton gestations <20wks comparing early GDM screening (14-20 wks) to routine (24-28 wks). GDM screening was performed using a 50-g, 1-hr glucose challenge test followed by a 100-g, 3-hr glucose tolerance test if ≥135 mg/dL. GDM was diagnosed using Carpenter Coustan criteria. HbA1c was measured on all patients; the provider was notified and GDM diagnosed if ≥6.5. Women not diagnosed at 14-20 wks were rescreened at 24-28 wks. Exclusion criteria were diabetes, major medical illness (cardiac, hemoglobinopathy, prednisone), bariatric surgery, and prior cesarean. The primary outcome was a composite of macrosomia (>4000g), primary cesarean, hypertensive disease of pregnancy (PIH), shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia. We estimated a 50% incidence of the primary composite outcome; to detect a 50% reduction in the GDM patients (α=0.05, β=0.2), 58 GDM patients per group were necessary. The total sample size of 950 estimated a 14% incidence of GDM in obese women. This sample would also have 80% power to detect a 10% absolute change in the primary outcome for the entire population. Of 954 women enrolled, 912 (95.6%) had outcomes. Randomization groups were balanced at baseline for race, BMI, nulliparity, gestational age at randomization, and HbA1c. Of the 454 (49.7%) randomized to early screening, 69 (15.2%) were diagnosed with GDM: 29 (6.4%) <20 wks and 40 (8.8%) >24 wks. Of 458 randomized to routine screening, 56 (12.2%) had GDM. Early screening did not reduce the incidence of the primary outcome as it was nominally higher in the early group (59.0% vs 53.3%, p=0.08, Table 1). PIH was not reduced in the early group (13.5% vs 9.6%, p=0.06). Use of insulin was significantly increased in the early group (2.6% vs 0.7%, p=0.02). These findings were consistent when only those with GDM were compared (Table 2); considering only GDM, women in the early group were delivered earlier than the routine. In this RCT, early GDM screening in obese women was not beneficial and may have been harmful. Recommendations for early GDM screening need to be reassessed in light of these findings.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

501: Hemoglobin A1c for early gestational diabetes screening in obese women

501: Hemoglobin A1c for early gestational diabetes screening in obese women

Controversies in Screening and Diagnostic Criteria for Gestational Diabetes in Early and Late Pregnancy.

This review serves to evaluate the screening and diagnostic strategies for gestational diabetes and overt diabetes in pregnancy. We focus on the different early screening and diagnostic approaches in first trimester including fasting plasma glucose, random plasma glucose, oral glucose tolerance test, hemoglobin A1c, risk prediction models and biomarkers. Early screening for gestational diabetes is currently not recommended since the potential benefits and harms of early detection and subsequent treatment need to be further evaluated in randomized controlled trials.

Early screening for gestational diabetes in obese pregnant women is associated with improved neonatal and maternal outcomes

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Impact of Early Screening for Gestational Diabetes on Perinatal Outcomes in High-Risk Women.

Objective To examine the benefits of early gestational diabetes mellitus (GDM) screening in a high-risk population. Study Design Retrospective cohort of all singletons diagnosed with GDM with indications for early screening: GDM or macrosomia in a prior pregnancy or obesity. Subjects were classified as early (<20 weeks) or routine (>24 weeks) screening. Patients diagnosed with GDM were managed according to standard institutional protocols. Outcomes examined were cesarean delivery (CD), preeclampsia, large for gestational age (LGA), small for gestational age (SGA), macrosomia, and preterm birth (PTB). Results Subjects screened early were more likely to have had GDM in a prior pregnancy, hypertension, higher body mass index, and higher fasting glucose. Early and routine screening groups had similar incidences of CD (adjusted odds ratio [AOR] 0.95, 95% confidence interval [CI] 0.55-1.64), preeclampsia (AOR 0.84, 95% CI 0.38-1.83), LGA (AOR 0.90, 95% CI 0.51-1.72), SGA (AOR 0.38, 95% CI 0.13-1.13), and macrosomia (AOR 1.00, 95% CI 0.53-1.87). Subjects in the early screening group had a higher incidence of PTB (AOR 1.79, 95% CI 1.08-2.99). Conclusion We did not detect a benefit to early screening for women who met the criteria. The utility of early GDM screening requires evaluation in a prospective trial.

Early Screening for Gestational Diabetes Leads to Success

Gestational diabetes mellitus (GDM) is a common complication that occurs during pregnancy, and the rate of diagnosis in the United States is on the rise. Early screening and treatment of GDM has the potential to make a positive difference for mothers and their infants. Multiple approaches for the screening of GDM have been recommended, including a two-step approach and a one-step approach. Since GDM may lead to an increased risk of birth defects, or may result in the development of type 2 diabetes for the mother after delivery, early treatment of GDM through diet, exercise, and possibly the administration of insulin and other medication can increase the chances of positive results.

Screening for Gestational Diabetes Mellitus: A Systematic Review for the U.S. Preventive Services Task Force

In 2003, the U.S. Preventive Services Task Force concluded that evidence was insufficient to advise for or against routinely screening all pregnant women for gestational diabetes mellitus. To review evidence about the benefits and harms of screening for gestational diabetes. Databases (MEDLINE, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, National Institute for Health and Clinical Effectiveness, and Cochrane Library) were searched for reports published from January 2000 to 15 November 2007 (and from 1966 to 1999 for additional studies on screening at less than 24 weeks' gestation), citations in the 2003 evidence report, and studies identified through consultation of experts and searches of bibliographies. English-language studies that used standard 1- or 2-step testing for gestational diabetes and that evaluated at least 1 of the following outcomes: neonatal mortality; brachial plexus injury; clavicular fracture; admission to a neonatal intensive care unit for hypoglycemia, hyperbilirubinemia, or the respiratory distress syndrome; maternal mortality; and preeclampsia or pregnancy-induced hypertension. 2 reviewers evaluated 1607 abstracts, critically appraised 288 articles, and qualitatively synthesized 13 studies. No randomized, controlled trials that directly evaluated the risks and benefits of gestational diabetes screening were found. One good-quality randomized, controlled trial of treatment of mild gestational diabetes in a screening-detected population supported a reduction in serious neonatal complications and showed that gestational diabetes treatment also reduced the risk for gestational hypertension. Very limited evidence was found to evaluate early screening for gestational diabetes (before 24 weeks' gestation). Limited evidence suggests that serious maternal hypoglycemia is rare with treatment and that overall quality of life is not worse among women receiving gestational diabetes treatment compared with women not receiving treatment. The literature is limited by lack of a consistent standard for screening or diagnosis of gestational diabetes. Limited evidence suggests that gestational diabetes treatment after 24 weeks improves some maternal and neonatal outcomes. Evidence is even more sparse for screening before 24 weeks' gestation.