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Cited by 153Gestational Diabetes Research and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

Different strategies for diagnosing gestational diabetes to improve maternal and infant health

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Farrar, Diane, Duley, Lelia, Dowswell, Therese, Lawlor, Debbie A·2017·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd007122.pub4PMC PMC6483546
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Abstract

BACKGROUND: Gestational diabetes mellitus (GDM) is carbohydrate intolerance resulting in hyperglycaemia with onset or first recognition during pregnancy. If untreated, perinatal morbidity and mortality may be increased. Accurate diagnosis allows appropriate treatment. Use of different tests and different criteria will influence which women are diagnosed with GDM. This is an update of a review published in 2011 and 2015. OBJECTIVES: To evaluate and compare different testing strategies for diagnosis of gestational diabetes mellitus to improve maternal and infant health while assessing their impact on healthcare service costs. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (9 January 2017) and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised trials if they evaluated tests carried out to diagnose GDM. We excluded studies that used a quasi-random model, cluster-randomised or cross-over trials. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: We included a total of seven small trials, with 1420 women. One trial including 726 women was identified by this update and examined the two step versus one step approach. These trials were assessed as having varying risk of bias, with few outcomes reported. We prespecified six outcomes to be assessed for quality using the GRADE approach for one comparison: 75 g oral glucose tolerance test (OGTT) versus 100 g OGTT; data for only one outcome (diagnosis of gestational diabetes) were available for assessment. One trial compared three different methods of delivering glucose: a candy bar (39 women), a 50 g glucose polymer drink (40 women) and a 50 g glucose monomer drink (43 women). We have included the results reported by this trial as separate comparisons. No trial reported on measures of costs of health services.We examined six main comparisons. 75 g OGTT versus 100 g OGTT (1 trial, 248 women): women who received 75 g OGTT had a higher relative risk of being diagnosed with GDM (risk ratio (RR) 2.55, 95% confidence interval (CI) 0.96 to 6.75; very-low quality evidence). No data were reported for the following additional outcomes prespecified for GRADE assessment: caesarean section, macrosomia > 4.5 kg or however defined in the trial, long-term type 2 diabetes maternal, long-term type 2 diabetes infant and economic costs. Candy bar versus 50 g glucose monomer drink (1 trial, 60 women): more women receiving the candy bar, rather than glucose monomer, preferred the taste of the candy bar (RR 0.60, 95% CI 0.42 to 0.86) and 1-hour glucose was less with the candy bar. There were no differences in the other outcomes reported (maternal side effects). No infant outcomes were reported or any review primary outcomes. 50 g glucose polymer drink versus 50 g glucose monomer drink (3 trials, 239 women): mean difference (MD) in gestation at birth was -0.80 weeks (1 trial, 100 women; 95% CI -1.69 to 0.09). Total side effects were less common with the glucose polymer drink (1 trial, 63 women; RR 0.21, 95% CI 0.07 to 0.59), and no clear difference in taste acceptability was reported (1 trial, 63 women; RR 0.99, 95% CI 0.76 to 1.29). Fewer women reported nausea following the 50 g glucose polymer drink compared with the 50 g glucose monomer drink (1 trial, 66 women; RR 0.29, 95% CI 0.11 to 0.78). No other measures of maternal morbidity or outcomes for the infant were reported. 50 g glucose food versus 50 g glucose drink (1 trial, 30 women): women receiving glucose in their food, rather than as a drink, reported fewer side effects (RR 0.08, 95% CI 0.01 to 0.56). No clear difference was noted in the number of women requiring further testing (RR 0.14, 95% CI 0.01 to 2.55). No other measures of maternal morbidity or outcome were reported for the infant or review primary outcomes. 75 g OGTT World Health Organization (WHO) criteria versus 75 g OGTT American Diabetes Association (ADA) criteria (1 trial, 116 women): no clear differences in included outcomes were observed between women who received the 75 g OGTT and were diagnosed using criteria based on WHO (1999) recommendations and women who received the 75 g OGTT and were diagnosed using criteria recommended by the ADA (1979). Outcomes measured included diagnosis of gestational diabetes (RR 1.47, 95% CI 0.66 to 3.25), caesarean section (RR 1.07, 95% CI 0.85 to 1.35), macrosomia defined as > 90th percentile by ultrasound or birthweight equal to or exceeding 4000 g (RR 0.73, 95% CI 0.19 to 2.79), stillbirth (RR 0.49, 95% CI 0.02 to 11.68) and instrumental birth (RR 0.21, 95% CI 0.01 to 3.94). No other secondary outcomes were reported. Two-step approach (50 g oral glucose challenge test followed by selective 100 g OGTT Carpente

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  1. Relavent biomarkers, e.g. cord C-peptide, cord insulin (non-prespecified outcome).* The outcome plasma glucose was not originally specified in the protocol but was added in the first version of this review. Methods have been updated to current Cochrane Pregnancy and Childbirth Group standard text, and a 'Summary of findings' table has been incorporated. Published notes Characteristics of studies Characteristics of included studies Mexico 2003 [CRSSTD: 2890367]
  2. Bebbington MW, Milner R, Wilson RD, Harris S. A randomized controlled trial comparing routine screening vs selected screening for gestational diabetes in low risk population. American Journal of Obstetrics and Gynecology 1999;180(1 Pt 2):S36. [CRSREF: 2890374] Canada 2005 [CRSSTD: 2890375]
  3. Tierney M, O'Dea A, Danyliv A, Glynn L, Mcguire B, Carmody L, et al. The rate of uptake and clinical effectiveness of gestational diabetes mellitus screening in primary vs. secondary care. Diabetes 2015;64:A676. [CRSREF: 6572696
  4. Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

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Authors
Farrar, D., Duley, L., Dowswell, T., & Lawlor, D. A.
Affiliations
  • Bradford Royal Infirmary (GB)
  • Queen's Medical Centre (GB)
  • Brigham and Women's Hospital (US)
  • University of Bristol (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2017-08-23
Volume
2017
Issue
8
Pages
CD007122-CD007122
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd007122.pub4
PMC
PMC6483546
OpenAlex
W2146708180
Cited by
153
References
122
Citations by year
2026: 6 · 2025: 2 · 2024: 8 · 2023: 12 · 2022: 12 · 2021: 19 · 2020: 14 · 2019: 18 · 2018: 21 · 2017: 8 · 2016: 9 · 2015: 10 · 2014: 2 · 2013: 8 · 2012: 3
FWCI
2.86
Type
journal article
Language
en
Open access
Licence
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion, other-oa)
  • Bristol Research (University of Bristol) (submittedVersion, other-oa)
Funders
National Institute for Health and Care Research (NF-SI-0611-10196, 13/89/05)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
gestational diabetes mellitus, GDM diagnosis, oral glucose tolerance test, 75 g OGTT, maternal outcomes, perinatal outcomes, health care costs, diagnostic accuracy, risk of bias, cesarean section
MeSH terms
Beverages, Candy, Female, Glucose, Glucose Tolerance Test, Humans, Infant Welfare, Infant, Newborn, Maternal Welfare, Pregnancy, Prenatal Exposure Delayed Effects, Randomized Controlled Trials as Topic, Diabetes, Gestational

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