Gabriele Saccone1, Claudia Caissutti2, Adeeb Khalifeh3, Sara Meltzer4, Christina Scifres5, Hyagriv N Simhan6, Sefa Kelekci7, Osman Sevket8, Vincenzo Berghella3. 1. a Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine , University of Naples "Federico II" , Naples , Italy. 2. b Department of Experimental Clinical and Medical Science, DISM, Clinic of Obstetrics and Gynecology , University of Udine , Udine , Italy. 3. c Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA. 4. d Division of Endocrinology and Metabolism, Department of Medicine and Obstetrics and Gynecology, Faculty of Medicine , McGill University , Montreal , Canada. 5. e Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA. 6. f Department of Obstetrics, Division of Maternal Fetal Medicine, Gynecology and Reproductive Sciences , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA. 7. g Department of Obstetrics and Gynecology, School of Medicine , Izmir Katip Celebi University , Izmir , Turkey. 8. h Department of Obstetrics and Gynecology , Bezmialem Vakif University, School of Medicine , Istanbul , Turkey.
Abstract
INTRODUCTION: To compare both the prevalence of gestational diabetes mellitus (GDM) as well as maternal and neonatal outcomes by either the one-step or the two-step approaches. MATERIAL AND METHODS: Electronic databases were searched from their inception until June 2017. We included all randomized controlled trials (RCTs) comparing the one-step with the two-step approaches for the screening and diagnosis of GDM. The primary outcome was the incidence of GDM. RESULTS: Three RCTs (n = 2333 participants) were included in the meta-analysis. 910 were randomized to the one step approach (75 g, 2 hrs), and 1423 to the two step approach. No significant difference in the incidence of GDM was found comparing the one step versus the two step approaches (8.4 versus 4.3%; relative risk (RR) 1.64, 95%CI 0.77-3.48). Women screened with the one step approach had a significantly lower risk of preterm birth (PTB) (3.7 versus 7.6%; RR 0.49, 95%CI 0.27-0.88), cesarean delivery (16.3 versus 22.0%; RR 0.74, 95%CI 0.56-0.99), macrosomia (2.9 versus 6.9%; RR 0.43, 95%CI 0.22-0.82), neonatal hypoglycemia (1.7 versus 4.5%; RR 0.38, 95%CI 0.16-0.90), and admission to neonatal intensive care unit (NICU) (4.4 versus 9.0%; RR 0.49, 95%CI 0.29-0.84), compared to those randomized to screening with the two step approach. CONCLUSIONS: The one and the two step approaches were not associated with a significant difference in the incidence of GDM. However, the one step approach was associated with better maternal and perinatal outcomes.
INTRODUCTION: To compare both the prevalence of gestational diabetes mellitus (GDM) as well as maternal and neonatal outcomes by either the one-step or the two-step approaches. MATERIAL AND METHODS: Electronic databases were searched from their inception until June 2017. We included all randomized controlled trials (RCTs) comparing the one-step with the two-step approaches for the screening and diagnosis of GDM. The primary outcome was the incidence of GDM. RESULTS: Three RCTs (n = 2333 participants) were included in the meta-analysis. 910 were randomized to the one step approach (75 g, 2 hrs), and 1423 to the two step approach. No significant difference in the incidence of GDM was found comparing the one step versus the two step approaches (8.4 versus 4.3%; relative risk (RR) 1.64, 95%CI 0.77-3.48). Women screened with the one step approach had a significantly lower risk of preterm birth (PTB) (3.7 versus 7.6%; RR 0.49, 95%CI 0.27-0.88), cesarean delivery (16.3 versus 22.0%; RR 0.74, 95%CI 0.56-0.99), macrosomia (2.9 versus 6.9%; RR 0.43, 95%CI 0.22-0.82), neonatal hypoglycemia (1.7 versus 4.5%; RR 0.38, 95%CI 0.16-0.90), and admission to neonatal intensive care unit (NICU) (4.4 versus 9.0%; RR 0.49, 95%CI 0.29-0.84), compared to those randomized to screening with the two step approach. CONCLUSIONS: The one and the two step approaches were not associated with a significant difference in the incidence of GDM. However, the one step approach was associated with better maternal and perinatal outcomes.
Authors: Maisa N Feghali; Kaleab Z Abebe; Diane M Comer; Steve Caritis; Janet M Catov; Christina M Scifres Journal: Diabetes Res Clin Pract Date: 2018-02-08 Impact factor: 5.602