One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial

Abstract

ObjectivesThere is considerable worldwide controversy regarding optimal screening and diagnostic approaches for GDM. This study aimed to compare the prevalence, maternal and neonatal outcomes of a One-step with a Two-step approach for the screening and diagnosis of GDM in a large community sample of pregnant women.MethodsWe conducted a secondary analysis of a randomized community non-inferiority trial of GDM screening in Iran. For the current study, all pregnant women who met the inclusion criteria were randomized into two groups for GDM screening. The first group of women (n = 14611) was screened by a One-step screening approach [75-g 2-h oral glucose tolerance test (OGTT)] and the second group (n = 14160) by a Two-step method (the 50-g glucose challenge test followed by the 100-g OGTT). All study participants were followed up until delivery, and the adverse maternal and neonatal outcomes were recorded in detail.ResultsGDM was diagnosed in 9.3% of the pregnant women who were assigned to the One-step and in 5.4% of those assigned to the Two-step approach with a statistically significant difference between them (p < 0.001). Intention-to-treat analyses showed no significant differences between the One-step and the Two-step group in the unadjusted risks of the adverse pregnancy outcomes of macrosomia, primary cesarean-section, preterm birth, hypoglycemia, hypocalcemia, hyperbilirubinemia, preeclampsia, neonatal intensive care unit admission, birth trauma, low birth weight, and intrauterine fetal death. Results remained unchanged after adjustment for potential confounder variables including gestational age at enrollment and delivery, maternal body mass index, gestational weight gain, type of delivery, treatment modality, and GDM diagnosis in the first trimester.ConclusionWe found that although the rates of GDM more than doubled with the One-step strategy, the One-step approach was similar to the Two-step approach in terms of maternal and neonatal outcomes. These findings may warn that more caution should be exercised in adopting the One-step method worldwide. Future research is needed to assess the long-term harm and benefits of those approaches to GDM screening for both mothers and their offspring.Clinical trial registrationhttps://www.irct.ir/trial/518, identifier (IRCT138707081281N1).

Prevalance of impaired glucose tolerance and its association with adverse perinatal outcomes in non-gestational diabetes pregnancies

“…In literature, different groups and societies recommend different approaches and criteria for screening and diagnosis of GDM (1,33,(37)(38)(39)(40). Most common known screening strategies are one step 75g 2h test using The International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria (33) and two step 50g 1h followed for abnormals by 100gr 3h test using C&C criteria (37,40).…”

Routine screening for gestational diabetes: a review

“…Although the clinical utility of early screening is still being investigated, others have attempted to determine whether managing early hyperglycemia improves outcomes. Several small clinical trials have since shown that management of early pregnancy hyperglycemia did not improve maternal or neonatal outcomes [23,24 ▪ ,25 ▪ ]. Most recently, a large, multicenter trial randomized participants with early GDM (diagnosed by 75-g OGTT) to either receive immediate treatment or delayed treatment pending results of routine GDM testing at 24–28 weeks [26 ▪ ].…”