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Screening for Gestational Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement FREE

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The full report is titled “Screening for Gestational Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 18 March 2014 issue of Annals of Internal Medicine (volume 160, pages 414-420). The author is V.A. Moyer, on behalf of the U.S. Preventive Services Task Force.

This article was published online first at www.annals.org on 14 January 2014.

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

Ann Intern Med. 2014;160(6):I-30. doi:10.7326/P14-9011
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Who developed these recommendations?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

When diabetes, or abnormally high blood sugar, occurs during pregnancy, it is called gestational diabetes mellitus. Women with gestational diabetes are at risk for complications, such as very large babies, difficult labor and delivery, and stillbirth. Being overweight, being older than 25 years of age, or having family members with diabetes increases a woman's risk for gestational diabetes.

The treatment of gestational diabetes includes a special diet and possibly insulin injections. If a pregnant woman develops diabetes symptoms (increased thirst, frequent urination), she should be checked for gestational diabetes. But many women with gestational diabetes have no symptoms, so some doctors do tests to check for it around the 24th week of pregnancy, even if a woman has no symptoms. Testing people without symptoms is called screening. In 2008, the USPSTF found that there was not enough information to know whether there are any benefits to screening for gestational diabetes during pregnancy and recommended that whether to screen should depend on how a woman and her doctor weigh the potential benefits (fewer very large babies and uncertain other benefits) and harms (anxiety, false-positive results). The USPSTF wanted to update the 2008 recommendation on the basis of information that has become available since that time.

How did the USPSTF develop these recommendations?

The authors reviewed published research to measure the benefits and harms of screening pregnant women for gestational diabetes.

What did the authors find?

The USPSTF found that primary care providers can accurately detect gestational diabetes in women without symptoms after 24 weeks of pregnancy. The most commonly used test in the United States is the 50-gram oral glucose challenge. Research on other screening methods was limited. The USPSTF found adequate evidence that treating screen-detected gestational diabetes (with diet changes, blood sugar monitoring, and insulin if needed) reduces the risk for preeclampsia, very large babies, and shoulder injury to babies during birth. However, the USPSTF found insufficient information about the benefits and harms of screening earlier than the 24th week of pregnancy.

What does the USPSTF recommend that patients and doctors do?

The USPSTF recommends that doctors screen women without diabetes symptoms for gestational diabetes after the 24th week of pregnancy.

The decision to screen earlier than 24 weeks should be based on the doctor and patient considering the risks and benefits. Factors that might influence a decision to screen early include whether the women is obese, has a family history of type 2 diabetes, or has a history of having large babies.

What are the cautions related to these recommendations?

These recommendations do not apply to pregnant women who have diabetes symptoms. If symptoms are present, the woman should have diabetes testing. Recommendations may change as new studies become available.





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