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Early gestational diabetes screening in women at risk for gestational diabetes: a randomized controlled trial

      Objective

      To assess if early gestational diabetes (GDM) screening is associated with improved perinatal outcomes.

      Study Design

      Participants who met ACOG 2013 Practice Bulletin risk factors for GDM were randomized to two screening groups: glucose screen at 12-18 weeks’ (early) or at 24-28 weeks’ (usual care). Two step screening was performed and gestational diabetes was diagnosed using Carpenter−Coustan criteria. Women with a negative test at 12-18 weeks’ were rescreened at 24 to 28 weeks’. All patients diagnosed with GDM were treated following institutional protocols. The primary outcome was a composite term which included perinatal mortality (stillbirth or neonatal death), neonatal hypoglycemia, hyperbilirubinemia, shoulder dystocia, respiratory distress and birth trauma. Data were analyzed by intention to treat principle. Chi square and Student’s t-test were used where appropriate. P< .05 was considered significant.

      Results

      A total of 1018 women were randomized, of those 78 had either a miscarriage or withdrew from the study, for a total of 940 participants that continued in the study. Among them, 118(12.5%) were diagnosed with GDM; 60 (early) and 58 (usual care) had complete outcomes and were analyzed. Both groups had similar demographic characteristics. The early screen group when compared to the usual care group, had a similar prepregnancy BMI (34.5±9.2 vs 34.7±10.2kg/m2), gestational age of delivery (37.8 ±3.9 vs 37.9± 3.8 weeks), cesarean delivery rate (43 vs 42.9, p=.9), preeclampsia (5.5 vs. 4.9%, p=.93) and neonatal birthweight (3198±681 vs. 3225±665gm, p=.56). Both groups were similar in the occurrence of shoulder dystocia (1.2 vs 1.8%, p=NS), neonatal hypoglycemia (9.9 vs 10.9%, p=.87), hyperbilirubinemia (14.7 vs 13.5%, p=.82) and respiratory distress syndrome (6.5 vs6.5%, p=.89). Composite neonatal outcome were similar between both groups (28.4 vs 29.3%, p=.82).

      Conclusion

      In our study early glucose screening in women at high risk for gestational diabetes was not associated with improved perinatal outcomes