Gavin Young, MD
What are the benefits and harms for mother and baby of screening for and treating gestational diabetes mellitus (GDM)?
The review sought to answer the questions: Are screening tests for GDM accurate? Does screening and treatment for GDM reduce perinatal morbidity and mortality in the mother and infant? What are the harms associated with these interventions? Neonatal outcomes were mortality and morbidity; maternal outcomes were mortality, preeclampsia, and pregnancy-induced hypertension.
MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, and National Institute for Health and Clinical Excellence (NICE) (2000 to Nov 2007); and references (including the previous US Preventive Services Task Force [USPSTF] review) were searched for randomized controlled trials (RCTs) and prospective cohort studies that used a 1- or 2-step screening method and recognized diagnostic criteria for GDM. MEDLINE (1966 to 1999) was searched for studies about screening for GDM at ≤ 24 weeks of gestation. Experts were consulted. 7 RCTs (n = 2469), 4 prospective cohort studies (n = 793), and 1 cross-sectional study (n = 118) met the selection criteria.
No appropriate study was found on benefits or accuracy of screening for GDM. The Table shows results of 7 RCTs on treatment of GDM at > 24 weeks of gestation. 3 observational studies (n = 427) found that a positive screening result had no lasting adverse effect on maternal anxiety or depression. 6 RCTs (n = 1536) and 1 observational study (n = 301) found no adverse effect of GDM treatment (compared with no treatment, less-intensive treatment, or standard treatment) on maternal psychological outcomes or hypoglycemia; limited data showed no evidence of harm to the fetus.
Little evidence exists on the benefits and harms of screening for gestational diabetes. Limited evidence suggests that treatment of gestational diabetes after 24 weeks of gestation may improve maternal and neonatal outcomes.
Randomized controlled trials of treatment for gestational diabetes at > 24 weeks of gestation*
*NICU = neonatal intensive care unit; NPH = neutral protamine Hagedorn; PIH = pregnancy-induced hypertension; RR = relative risk; other abbreviations defined in Glossary.
Young G. Review: Little evidence exists on the benefits and harms of screening for and treating gestational diabetes. Ann Intern Med. ;149:JC3–8. doi: 10.7326/0003-4819-149-6-200809160-02008
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Published: Ann Intern Med. 2008;149(6):JC3-8.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Prevention/Screening.
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