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Weekly courses of antenatal corticosteroids did not reduce composite neonatal morbidity compared with a single course of treatment. Weekly courses of antenatal corticosteroids should not be routinely prescribed for women at risk of preterm delivery.

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Gestational diabetes mellitus (GDM) affects up to 25% of pregnant women and increases the risk of a number of adverse maternal and neonatal outcomes. There are 2 screening approaches for GDM: 1-step screening preferred by the American Diabetes Association and 2-step screening recommended by the American College of Obstetricians and Gynecologists. The 1-step approach from the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) involves a 2-hour, fasting oral glucose tolerance test (OGTT); the 2-step Carpenter-Coustan approach involves an initial, nonfasting, 1-hour glucose test, followed by a 3-hour fasting OGTT, if the first test result is positive. The aim of this study was to compare the 2 screening approaches for GDM on maternal and neonatal outcomes.This was a randomized trial, including data from all pregnant women who received care from Kaiser Permanente Northwest and Kaiser Permanente Hawaii. The women were randomly assigned to receive the 1-step approach or the 2-step approach during their first prenatal visit. Randomization occurred at both sites from May 28, 2014, to December 31, 2017. The primary outcomes were GDM diagnosis; large for gestational age (birth weight > 90th percentile); perinatal composite outcome that included stillbirth, neonatal death, shoulder dystocia, bone fracture, or nerve palsy related to a birth injury; cesarean delivery; and gestational hypertension or preeclampsia.A total of 23,792 were randomized into the 1-step approach (with 66% being adherent) and 2-step approach (with 92% being adherent). The 1-step approach diagnosed GDM in 16.5% of women and the 2-step approach diagnosed GDM in 8.5% (relative risk [RR], 1.94; 97.5% confidence interval [CI], 1.79-2.11). Comparing the 1-step approach with the 2-step approach, there were no significant differences on outcomes for large-for-gestational-age infants (8.