Screening and Diagnosing Gestational Diabetes Mellitus: Structured Abstract

Screening and Diagnosing Gestational Diabetes Mellitus: Structured Abstract

Gestational Diabetes

Full Title: Screening and Diagnosing Gestational Diabetes Mellitus November 2012 This review aims to identify the properties of screening and diagnostic tests for gestational diabetes mellitus (GDM), to evaluate the potential benefits and harms of screening, to assess the effects of different screening and diagnostic thresholds on outcomes for mothers and their offspring, and to determine the effects of treatment in modifying outcomes for women diagnosed with GDM. View or download Report Structured Abstract Background: There is uncertainty as to the optimal approach for screening and diagnosis of gestational diabetes mellitus (GDM). Based on systematic reviews published in 2003 and 2008, the U.S. Preventive Services Task Force concluded that there was insufficient evidence upon which to make a recommendation regarding routine screening of all pregnant women. Objectives: Identify properties of screening tests for GDM. Evaluate benefits and harms of screening for GDM. Assess the effects of different screening and diagnostic thresholds on outcomes for mothers and their offspring. Determine the benefits and harms of treatment for a diagnosis of GDM. Data Sources: We searched 15 electronic databases from 1995 to May 2012, including MEDLINE® and Cochrane Central Register of Controlled Trials (which contains the Cochrane Pregnancy and Childbirth Group registry); gray literature; Web sites of relevant organizations; trial registries; and reference lists. Methods: Two reviewers independently conducted study selection and quality assessment. One reviewer extracted data, and a second reviewer verified the data. We included published randomized and nonrandomized controlled trials and prospective and retrospective cohort studies that compared any screening or diagnostic test with any other screening or diagnostic test; any screening with no screening; women who met various thresholds for GDM with those who did not meet various criteria, where women in both groups did not receive treatment; any treatment for GDM with no treatment. We conducted a descriptive analysis for all studies and meta-analyses when appropriate. Key outcomes included preeclampsia, maternal weight gain, birth injury, shoulder dystocia, neonatal hypoglycemia, macrosomia, and long-term metabolic outcomes for the child and mother. Results: The search identified 14,398 citations and included 97 studies (6 randomized controlled trials, 63 prospective cohort studies, and 28 retrospective cohort studies). Prevalence of GDM varied across studies and diagnostic criteria: American Diabetes Association (75 g) 2 to 19 percent; Carpenter and Coustan 3.6 to 38 percent; National Diabetes Data Group 1.4 to 50 percent; and World Health Organization 2 to 24.5 percent. Lack of a gold standard for the diagnosis of GDM and little evidence about the accuracy of screening strategies for GDM remain problematic. The 50 g oral glucose challenge test with a glucose threshold of 130 mg/dL versus 140 mg/dL improves sensitivity and reduces specificity. Both thresholds have high negative predictive values (NPV) but variable positive predictive values (PPVs) across a range of prevalence. There was limited evidence for the screening of GDM diagnosed less than 24 weeks’ gestation (three studies). One study compared the International Association of Diabetes in Pregnancy Study Groups’ (IADPSG) diagnostic criteria with a two-step strategy. Sensitivity was 82 percent, specificity was 94 percent. Only two studies examined the effects on health outcomes from screening for GDM. One retrospective cohort study (n=1,000) showed more cesarean deliveries in the screened group. A survey within a prospective cohort study (n=93) found the same incidence of macrosomia (≥4.3 kg) in screened and unscreened groups (7 percent each group). Thirty-eight studies examined health outcomes for women who met different criteria for GDM and did not undergo treatment. Methodologically strong studies showed a continuous positive relationship between increasing glucose levels and the incidence of primary cesarean section and macrosomia. One of these studies also found significantly fewer cases of preeclampsia, cesarean section, shoulder dystocia and/or birth injury, clinical neonatal hypoglycemia, and hyperbilirubinemia for women without GDM compared with those meeting IADPSG criteria. Among the other studies, fewer cases of preeclampsia were observed for women with no GDM and women who were false positive versus those meeting Carpenter and Coustan criteria. For maternal weight gain, few comparisons showed differences. For fetal birth trauma, single studies showed no differences for women with Carpenter and Coustan GDM and World Health Organization impaired glucose tolerance versus women without GDM. Women diagnosed based on National Diabetes Data Group GDM had more fetal birth trauma compared with women without GDM. Fewer cases of macrosomia were seen in the group without GDM compared with Carpenter and Coustan GDM, Carpenter and Coustan 1 abnormal oral glucose tolerance test, National Diabetes Data Group GDM, National Diabetes Data Group false positives, and World Health Organization impaired glucose tolerance. Fewer cases of neonatal hypoglycemia were found among patient groups without GDM compared with those meeting Carpenter and Coustan criteria. There was more childhood obesity for Carpenter and Coustan GDM versus patient groups with no GDM. Eleven studies compared diet modification, glucose monitoring, and insulin as needed with no treatment. Moderate evidence showed fewer cases of preeclampsia in the treated group. The evidence was insufficient for maternal weight gain and birth injury. Moderate evidence found less shoulder dystocia with treatment for GDM. Low evidence showed no difference for neonatal hypoglycemia between treated and untreated GDM. Moderate evidence showed benefits of treatment for reduction of macrosomia (>4,000 g). There was insufficient evidence for long-term metabolic outcomes among offspring. Five studies provided data on harms of treating GDM. No difference was found for cesarean delivery, induction of labor, small for gestational age, or admission to a neonatal intensive care unit. There were significantly more prenatal visits among those treated. Conclusions: While evidence supports a positive association with increasing plasma glucose on a 75 g or 100 g oral glucose tolerance test and macrosomia and primary cesarean section, clear thresholds for increased risk were not found. The 50 g oral glucose challenge test has high NPV but variable PPV. Treatment of GDM results in less preeclampsia and macrosomia. Current evidence does not show that treatment of GDM has an effect on neonatal hypoglycemia or future poor metabolic outcomes. There is little evidence of short-term harm from treating GDM other than an increased demand for services. Research is needed on the long-term metabolic outcome for offspring as a result of GDM and its treatment, and the “real world” effects of GDM treatment on use of care. Download Report Screening and Diagnosing Gestational Diabetes Mellitus Executive Summary (Publication No. 12(13)-E021-1): (PDF File, 510 KB) Plugin Software Help. Evidence Report (Publication No. 12(13)-E021-EF). Evidence-based Practice Center: University of Alberta Current as of November 2012 Internet Citation: Screening and Diagnosing Gestational Diabetes Mellitus, Structured Abstract. November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/gdmexuptp.htm

Screening and Diagnosing Gestational Diabetes Mellitus: Structured Abstract

Opportunity for Public Comment (USPSTF) ► Screening Type 2 Diabetes Mellitus and Glucose Tolerance

Opportunity for Public Comment (USPSTF)

Screening Type 2 Diabetes Mellitus and Glucose Tolerance

The U.S. Preventive Services Task Force posted its draft Research Plan on screening for type 2 diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance. The draft Research Plan is available for review and public comment through May 29, 2013.  Given the childhood overweight and obesity epidemic, children and adolescents have experienced an increasing incidence of diabetes. 

Go to http://www.uspreventiveservicestaskforce.org/tfcomment.htm

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Screening for Type 2 Diabetes Mellitus, Impaired Fasting Glucose, and Impaired Glucose Tolerance

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  May 2–May 29, 2013

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Previous Opportunities for Public Comment

Screening for Suicide Risk in Adolescents, Adults, and Older Adults	April 23–May 21, 2013
Medications for Risk Reduction of Primary Breast Cancer in Women	April 16–May 13, 2013
Screening for Iron Deficiency Anemia in Childhood and Pregnancy (Draft Research Plan)	April 11–May 8, 2013
Screening for Oral Cancer	April 9–May 6, 2013
Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer (Draft Recommendation Statement and Evidence Report)	April 2–April 29, 2013
Screening for Autism Spectrum Disorder in Young Children (Draft Research Plan)	March 28–April 24, 2013
Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With Ankle Brachial Index in Adults (Draft Recommendation Statement and Evidence Report)	March 19–April 15, 2013
Screening for Gonorrhea and Chlamydia (Draft Research Plan)	March 7–April 3, 2013
Screening for Hypertension in Children and Adolescents	February 26–March 25, 2013
Screening for Vitamin D Deficiency (Draft Research Plan)	February 26–March 25, 2013
Screening for Glaucoma	February 19–March 18, 2013
Behavioral Counseling to Prevent Sexually Transmitted Infections	January 29–February 25, 2013
Behavioral Counseling to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Persons With Known Risk Factors	January 29–February 25, 2013
Primary Care Interventions to Prevent Child Maltreatment	January 22–February 18, 2013
Screening for Asymptomatic Carotid Artery Stenosis (Draft Research Plan)	January 15–February 11, 2013
Interventions to Reduce the Nonmedical Use of Drugs in Children and Adolescents (Draft Research Plan)	January 15–February 11, 2013
Interventions to Prevent Tobacco Use in Children and Adolescents	December 11, 2012–January 7, 2013
Screening for Hepatitis C Virus Infection in Adults	November 27–December 24, 2012
Screening for HIV	November 20–December 20, 2012
Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults (Draft Research Plan)	October 9–November 6, 2012
Screening and Behavioral Counseling in Primary Care to Reduce Alcohol Misuse	September 24–October 22, 2012
Prevention of Dental Caries in Preschool-Aged Children (Draft Research Plan)	July 10–August 7, 2012
Vitamin D and Calcium Supplementation to Prevent Cancer and Osteoporotic Fractures in Adults	June 12–July 10, 2012
Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults	June 12–July 10, 2012
Menopausal Hormone Therapy for the Prevention of Chronic Conditions	May 29–June 26, 2012
Screening for Chronic Kidney Disease	April 30–May 29, 2012
Screening for Ovarian Cancer	April 10–May 8, 2012
Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility (Draft Research Plan)	February 28–March 27, 2012
Screening for Peripheral Artery Disease (Draft Research Plan)	December 15, 2011–January 12, 2012
Screening for Coronary Heart Disease with Electrocardiography	November 30–December 13, 2011
Screening for Hearing Loss in Older Adults	November 30–December 13, 2011
Screening for Prostate Cancer	November 30–December 13, 2011
Counseling to Prevent Skin Cancer	November 8–December 6, 2011
Screening for Cervical Cancer	October 19–November 30, 2011
Screening and Management for Obesity in Adults	October 26–November 23, 2011
Screening for Prostate Cancer	October 11–November 8, 2011
Screening for Hearing Loss in Older Adults	October 4–November 1, 2011
Screening for Coronary Heart Disease with Electrocardiography	September 27–October 25, 2011
Screening and Treatment for Glaucoma	September 14–October 12, 2011
Counseling to Promote a Healthy Diet and Physical Activity in Adults	February 22, 2011–March 22, 2011
Falls Prevention in Older Adults	January 12, 2011–February 9, 2011
Screening for Bladder Cancer	November 30, 2010–December 28, 2010
Screening for Testicular Cancer	September 21, 2010–October 19, 2010
Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum	August 16, 2010–September 13, 2010
Screening for Osteoporosis	July 6, 2010–August 3, 2010

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Internet Citation:

Opportunities for Public Comment. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/tfcomment.htm