Background
Although in 2013 the American College of Obstetricians and Gynecologists recommended
early screening for gestational diabetes in obese women, no studies demonstrate an
improvement in perinatal outcomes with this strategy.
Objective
We sought to determine whether early screening for gestational diabetes improves perinatal
outcomes in obese women.
Materials and Methods
Randomized controlled trial comparing early gestational diabetes screening (14−20
weeks) to routine screening (24−28 weeks) in obese women (body mass index ≥30 kg/m2) at 2 tertiary care centers in the United States. Screening was performed using a
50-g, 1-hour glucose challenge test followed by a 100-g, 3-hour glucose tolerance
test if the initial screen was ≥135 mg/dL. Gestational diabetes was diagnosed using Carpenter−Coustan
criteria. Women not diagnosed at 14 to 20 weeks were rescreened at 24 to 28 weeks.
Exclusion criteria were pre-existing diabetes, major medical illness, bariatric surgery,
and prior cesarean delivery. The primary outcome was a composite of macrosomia (>4000
g), primary cesarean delivery, hypertensive disease of pregnancy, shoulder dystocia,
neonatal hyperbilirubinemia, and neonatal hypoglycemia (assessed within 48 hours of
birth).
Results
A total of 962 women were randomized, and outcomes were available for 922. Of these
922 women, 459 (49.8%) were assigned to early screen and 463 (50.2%) to routine screen.
Baseline characteristics were balanced between groups. In the early screening group,
69 (15.0%; 95% confidence interval, 11.9−18.6%) were diagnosed with gestational diabetes:
29 (6.3%; 95% confidence interval, 4.3−8.9%) at <20 weeks and 40 (8.7%; 95% confidence
interval, 6.3−11.7%) at >24 weeks. Of those randomized to routine screening, 56 (12.1%;
95% confidence interval, 9.3−15.4%) had gestational diabetes. Early screening did
not reduce the incidence of the primary outcome (56.9% in the early screen versus
50.8% in the routine screen, P = .07; relative risk, 1.12; 95% confidence interval, 0.99−1.26).
Conclusion
Early screening for gestational diabetes in obese women did not reduce the composite
perinatal outcome.
Key words
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Article info
Publication history
Published online: January 09, 2020
Accepted:
December 18,
2019
Received in revised form:
December 17,
2019
Received:
October 10,
2019
Footnotes
This trial was supported by K12HD001258-13 (PI WW Andrews).
The authors report no conflict of interest.
This study was funded in part by NICHD K12HD001258 and the UAB Center for Clinical and Translational Science (NIH/NCATS UL1TR001417).
Registered on clinicaltrials.gov, NCT01864564, on 5/29/13. First participant enrolled 6/18/13.
Cite this article as: Harper LM, Jauk V, Longo S, et al. Early gestational diabetes screening in obese women: a randomized controlled trial. Am J Obstet Gynecol 2020;222:495.e1-8.
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© 2019 Elsevier Inc. All rights reserved.
