Elsevier

Obstetrics & Gynecology

Volume 101, Issue 2, February 2003, Pages 380-392
Obstetrics & Gynecology

Review
Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force☆

https://doi.org/10.1016/S0029-7844(02)03057-0Get rights and content

Abstract

Objective

To systematically review the evidence for screening for gestational diabetes mellitus (GDM).

Data sources

We established eligibility criteria for relevant studies. We systematically searched MEDLINE and the Cochrane Collaboration Library for studies meeting eligibility criteria. We supplemented this search with further studies identified from reference lists of reviews.

Methods of study selection

Two reviewers examined each article for eligibility. A single reviewer abstracted relevant data from the included articles; a second reviewer checked the abstractions. We graded the quality of the articles according to criteria developed by the U.S. Preventive Services Task Force.

Tabulation, integration, and results

No well-conducted, randomized, controlled trial provides direct evidence for the health benefits of screening for GDM. The evidence is unclear regarding the optimal screening and reference diagnostic test for GDM. The impact of hyperglycemia on adverse maternal and neonatal health outcomes is probably continuous. Although insulin therapy decreases the incidence of fetal macrosomia for those women with more severe degrees of hyperglycemia, the magnitude of any effect on maternal and neonatal health outcomes is not clear. The evidence is insufficient to determine the magnitude of health benefit for any treatment among the large number of women with GDM at milder degrees of hyperglycemia. We found limited evidence regarding the potential adverse effects of screening for GDM.

Conclusion

Because of the lack of high-quality evidence concerning critical issues, we are unable to determine the extent to which screening has an important impact on maternal and neonatal health outcomes. A randomized, controlled trial of screening is necessary to answer the many remaining questions.

Section snippets

Sources

Our review of the literature was guided by key questions and inclusion criteria we developed relevant to the issue of screening for GDM (Table 1). We required RCTs for direct evidence of the efficacy of treatment and the harms associated with treatment. We examined the critical literature from the 1996 U.S. Preventive Services Task Force review and searched MEDLINE and the Cochrane Library for reviews and relevant studies published in English between January 1, 1994 and August 30, 2002. We

Study selection

All searches began by exploding the term “diabetes, gestational” and then proceeded by adding further terms. We retrieved the full text of all articles we thought were potentially eligible. Two reviewers examined each article for eligibility. A single reviewer abstracted relevant data from the included articles; a second reviewer checked the abstractions.

We abstracted all included articles, entered the data into evidence tables, graded the quality of all articles according to U.S. Preventive

Tabulation, integration, and results

For the U.S. Preventive Services Task Force to recommend screening for GDM, it must have either direct evidence from an RCT of screening or indirect evidence that establishes a complete linkage between screening and improved health outcomes. We found no well-conducted RCT that provides direct evidence for the health benefits of screening for GDM. Given this, the U.S. Preventive Services Task Force requires adequate evidence that 1) untreated GDM causes substantial maternal and/or neonatal

Conclusion

Maternal and neonatal morbidity increase with increasing levels of maternal hyperglycemia. Screening and intensive treatment for GDM aim to reduce this morbidity. Various screening strategies can detect women with different degrees of hyperglycemia, but the threshold at which health outcomes begin to deteriorate to a clinically important degree is uncertain.

The magnitude of any benefit of intensive treatment at the various levels of hyperglycemia associated with GDM is also uncertain, but it is

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    ☆

    Technical support for the U.S. Preventive Services Task Force: Agency for Healthcare Research and Quality, contract no. 290-97-0011, task order no. 3.

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    Copyright © 2003 The American College of Obstetricians and Gynecologists. Published by Elsevier Inc. All rights reserved.