Poster session II Clinical obstetrics, diabetes, labor, medical-surgical-disease, physiology/endocrinology, prematurity: Abstracts 237 - 386| Volume 208, ISSUE 1, SUPPLEMENT , S120-S121, January 01, 2013

264: The one-step method for screening and diagnosis of gestational diabetes: is it really better?


      There is a lack of consensus regarding the optimal method to diagnose gestational diabetes (GDM). The goal of this study was to test the hypothesis that the 1-step method for the diagnosis of GDM leads to earlier diagnosis, earlier intervention, and improved perinatal outcome when compared to the traditional 2-step method.

      Study Design

      A retrospective cohort study was performed by reviewing the charts of all patients with GDM enrolled in our Diabetes in Pregnancy Program (DIPP) from January 2009-May 2012. Before 10/2010, the 2-step method was used, with a 50-gm OGCT followed by a 100-gm OGTT. From 10/2010, the 75-gm OGTT 1-step method was used, as recommended by the American Diabetes Association. Exclusion criteria included: <18 years of age and initial GDM screening or testing before 24 weeks or after 34 weeks gestation. Data extracted included demographics, method and timing of diagnosis, treatment specifics, glucose control, delivery data, and neonatal outcomes. Neonatal outcomes were excluded from analysis for patients with multiple gestation or delivery < 37 weeks. Statistical analysis was performed using Chi square and Student's t-test.


      The study included 653 patients: 414 were diagnosed by the 2-step method and 239 by the 1-step method. The two groups differed with respect to gestational age (GA) at diagnosis, GA at entry into DIPP, GA at initiation of glyburide, GA at which good glycemic control was achieved, and medication dose at the end of pregnancy (Table). However, pregnancy outcome and newborn birthweight were similar in both groups.
      Tabled 1Data presented as mean±SD or %.
      Table thumbnail grr24


      Although the 1-step method leads to earlier diagnosis of GDM, earlier intervention, and achievement of glycemic control with lower doses of medications, it does not change neonatal outcome when compared to the traditional 2-step method.