Screening for Gestational Diabetes

Importance Gestational diabetes is associated with several poor health outcomes. Objective To update the 2012 review on screening for gestational to inform US Preventive Services Task Force. Data Sources MEDLINE, EMBASE, and CINAHL (2010 May 2020), ClinicalTrials.gov, reference lists; surveillance through June 2021. Study Selection English-language intervention studies treatment; observational screening; prospective test accuracy. Extraction Synthesis Dual of titles/abstracts, full-text articles, study quality. Single-reviewer data abstraction verification. Random-effects meta-analysis or bivariate analysis (accuracy). Main Outcomes Measures Pregnancy, fetal/neonatal, long-term outcomes; harms Results A total 76 were included (18 randomized clinical trials [RCTs] [n = 31 241], 2 nonrandomized 190], 56 261 678]). Direct evidence benefits vs no was limited 4 inconsistent findings methodological limitations. Screening not significantly serious harm. In 5 RCTs (n 25 772), 1-step (International Association Diabetes Pregnancy Study Group) 2-step (Carpenter Coustan) increased likelihood (11.5% 4.9%) but improved At after 24 weeks gestation, oral glucose challenge tests 140- 135-mg/dL cutoffs had sensitivities 82% 93%, respectively, specificities 79%, against Carpenter Coustan criteria, a 140-mg/dL cutoff sensitivity 85% specificity 81% National Group Data criteria. Fasting plasma 85 90 mg/dL 88% 73% 82%, Based 8 1 3982), treatment decreased risk primary cesarean deliveries (relative [RR], 0.70 [95% CI, 0.54-0.91]; absolute difference [ARD], 5.3%), shoulder dystocia (RR, 0.42 0.23-0.77]; ARD, 1.3%), macrosomia 0.53 0.41-0.68]; 8.9%), large age 0.56 0.47-0.66]; 8.4%), birth injuries (odds ratio, 0.33 0.11-0.99]; 0.2%), neonatal intensive care unit admissions 0.73 0.53-0.99]; 2.0%). The association reduction in preterm significant 0.75 0.56-1.01]). Conclusions Relevance remains limited. One-