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Screening And Diagnosing Gestational Diabetes Mellitus
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Book Synopsis Weight Gain During Pregnancy by : National Research Council
Download or read book Weight Gain During Pregnancy written by National Research Council and published by National Academies Press. This book was released on 2010-01-14 with total page 868 pages. Available in PDF, EPUB and Kindle. Book excerpt: As women of childbearing age have become heavier, the trade-off between maternal and child health created by variation in gestational weight gain has become more difficult to reconcile. Weight Gain During Pregnancy responds to the need for a reexamination of the 1990 Institute of Medicine guidelines for weight gain during pregnancy. It builds on the conceptual framework that underscored the 1990 weight gain guidelines and addresses the need to update them through a comprehensive review of the literature and independent analyses of existing databases. The book explores relationships between weight gain during pregnancy and a variety of factors (e.g., the mother's weight and height before pregnancy) and places this in the context of the health of the infant and the mother, presenting specific, updated target ranges for weight gain during pregnancy and guidelines for proper measurement. New features of this book include a specific range of recommended gain for obese women. Weight Gain During Pregnancy is intended to assist practitioners who care for women of childbearing age, policy makers, educators, researchers, and the pregnant women themselves to understand the role of gestational weight gain and to provide them with the tools needed to promote optimal pregnancy outcomes.
Author :U. S. Department of Health and Human Services Publisher :Createspace Independent Pub ISBN 13 :9781483943923 Total Pages :330 pages Book Rating :4.9/5 (439 download)
Book Synopsis Screening and Diagnosing Gestational Diabetes Mellitus by : U. S. Department of Health and Human Services
Download or read book Screening and Diagnosing Gestational Diabetes Mellitus written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-03-23 with total page 330 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gestational diabetes mellitus (GDM) is defined as glucose intolerance first discovered in pregnancy. Pregestational diabetes mellitus refers to any type of diabetes diagnosed before pregnancy. Pregnant women with pregestational diabetes experience an increased risk of poor maternal, fetal, and neonatal outcomes. The extent to which GDM predicts adverse outcomes for mother, fetus, and neonate is less clear. Depending on the diagnostic criteria used and the population screened, the prevalence of GDM ranges from 1.1 to 25.5 percent of pregnancies in the United States. The incidence of GDM has increased over the past decades in parallel with the increase in rates of obesity and type 2 diabetes mellitus, and this trend is expected to continue. It is unclear how much the increase in obesity will affect the proportion of women diagnosed with overt diabetes during pregnancy versus transient pregnancy-induced glucose intolerance. GDM is usually diagnosed after 20 weeks' gestation when placental hormones that have the opposite effect of insulin on glucose metabolism increase substantially. Women with adequate insulin secreting capacity overcome this insulin resistance of pregnancy by secreting more endogenous insulin to maintain normal blood glucose. Women with less adequate pancreatic reserve are unable to produce sufficient insulin to overcome the increase in insulin resistance, and glucose intolerance results. Glucose abnormalities in women with GDM usually resolve postpartum, but commonly recur in subsequent pregnancies. Women with GDM have an increased risk of future development of overt diabetes. The cumulative incidence of diabetes after a diagnosis of GDM varies widely depending on maternal body mass index (BMI), ethnicity, and time since index pregnancy, and it may reach levels as high as 60 percent. When glucose abnormalities persist postpartum in a woman with GDM, her diabetes is recategorized as overt diabetes. When this occurs, the likelihood that this woman had pregestational (i.e., overt) diabetes increases, especially if the diagnosis of GDM occurred before 20 weeks' gestation and glucose levels were markedly elevated in pregnancy. Based on systematic reviews published in 2003 and 2008, the USPSTF concluded that there was insufficient evidence upon which to make a recommendation regarding routine screening of all pregnant women for GDM. The primary aims of this review were to (1) identify the test properties of screening and diagnostic tests for GDM, (2) evaluate the potential benefits and harms of screening at greater than or equal to 24 weeks and less than 24 weeks' gestation, (3) assess the effects of different screening and diagnostic thresholds on outcomes for mothers and their offspring, and (4) determine the effects of treatment in modifying outcomes for women diagnosed with GDM. The benefits and harms of treatments were considered in this review to determine the downstream effects of screening on health outcomes. The intent of this review was also to assess whether evidence gaps in the previous USPSTF reviews have been filled. Key questions include: Key Question 1: What are the sensitivities, specificities, reliabilities, and yields of current screening tests for GDM? (a) After 24 weeks' gestation? (b) During the first trimester and up to 24 weeks' gestation? Key Question 2: What is the direct evidence on the benefits and harms of screening women (before and after 24 weeks' gestation) for GDM to reduce maternal, fetal, and infant morbidity and mortality? Key Question 3: In the absence of treatment, how do health outcomes of mothers who meet various criteria for GDM and their offspring compare to those who do not meet the various criteria? Key Question 4: Does treatment modify the health outcomes of mothers who meet various criteria for GDM and their offspring? Key Question 5: What are the harms of treating GDM and do they vary by diagnostic approach?
Book Synopsis Screening and Diagnosing Gestational Diabetes Mellitus by :
Download or read book Screening and Diagnosing Gestational Diabetes Mellitus written by and published by . This book was released on 2012 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: There is uncertainty as to the optimal approach for screening and diagnosis of gestational diabetes mellitus (GDM). Based on systematic reviews published in 2003 and 2008, the U.S. Preventive Services Task Force concluded that there was insufficient evidence upon which to make a recommendation regarding routine screening of all pregnant women. OBJECTIVES: (1) Identify properties of screening tests for GDM, (2) evaluate benefits and harms of screening for GDM, (3) assess the effects of different screening and diagnostic thresholds on outcomes for mothers and their offspring, and (4) determine the benefits and harms of treatment for a diagnosis of GDM. DATA SOURCES: We searched 15 electronic databases from 1995 to May 2012, including MEDLINE and Cochrane Central Register of Controlled Trials (which contains the Cochrane Pregnancy and Childbirth Group registry); gray literature; Web sites of relevant organizations; trial registries; and reference lists. METHODS: Two reviewers independently conducted study selection and quality assessment. One reviewer extracted data, and a second reviewer verified the data. We included published randomized and nonrandomized controlled trials and prospective and retrospective cohort studies that compared any screening or diagnostic test with any other screening or diagnostic test; any screening with no screening; women who met various thresholds for GDM with those who did not meet various criteria, where women in both groups did not receive treatment; any treatment for GDM with no treatment. We conducted a descriptive analysis for all studies and meta-analyses when appropriate. Key outcomes included preeclampsia, maternal weight gain, birth injury, shoulder dystocia, neonatal hypoglycemia, macrosomia, and long-term metabolic outcomes for the child and mother. RESULTS: The search identified 14,398 citations and included 97 studies (6 randomized controlled trials, 63 prospective cohort studies, and 28 retrospective cohort studies). Prevalence of GDM varied across studies and diagnostic criteria: American Diabetes Association (75 g) 2 to 19 percent; Carpenter and Coustan 3.6 to 38 percent; National Diabetes Data Group 1.4 to 50 percent; and World Health Organization 2 to 24.5 percent. Lack of a gold standard for the diagnosis of GDM and little evidence about the accuracy of screening strategies for GDM remain problematic. The 50 g oral glucose challenge test with a glucose threshold of 130 mg/dL versus 140 mg/dL improves sensitivity and reduces specificity. Both thresholds have high negative predictive values (NPV) but variable positive predictive values (PPVs) across a range of prevalence. There was limited evidence for the screening of GDM diagnosed less than 24 weeks' gestation (three studies). One study compared the International Association of Diabetes in Pregnancy Study Groups' (IADPSG) diagnostic criteria with a two-step strategy. Sensitivity was 82 percent, specificity was 94 percent. Only two studies examined the effects on health outcomes from screening for GDM. One retrospective cohort study (n=1,000) showed more cesarean deliveries in the screened group. A survey within a prospective cohort study (n=93) found the same incidence of macrosomia (|́Æ4.3 kg) in screened and unscreened groups (7 percent each group). Thirty-eight studies examined health outcomes for women who met different criteria for GDM and did not undergo treatment. Methodologically strong studies showed a continuous positive relationship between increasing glucose levels and the incidence of primary cesarean section and macrosomia. One of these studies also found significantly fewer cases of preeclampsia, cesarean section, shoulder dystocia and/or birth injury, clinical neonatal hypoglycemia, and hyperbilirubinemia for women without GDM compared with those meeting IADPSG criteria. Among the other studies, fewer cases of preeclampsia were observed for women with no GDM and women who were false positive versus those meeting Carpenter and Coustan criteria. For maternal weight gain, few comparisons showed differences. For fetal birth trauma, single studies showed no differences for women with Carpenter and Coustan GDM and World Health Organization impaired glucose tolerance versus women without GDM. Women diagnosed based on National Diabetes Data Group GDM had more fetal birth trauma compared with women without GDM. Fewer cases of macrosomia were seen in the group without GDM compared with Carpenter and Coustan GDM, Carpenter and Coustan 1 abnormal oral glucose tolerance test, National Diabetes Data Group GDM, National Diabetes Data Group false positives, and World Health Organization impaired glucose tolerance. Fewer cases of neonatal hypoglycemia were found among patient groups without GDM compared with those meeting Carpenter and Coustan criteria. There was more childhood obesity for Carpenter and Coustan GDM versus patient groups with no GDM. Eleven studies compared diet modification, glucose monitoring, and insulin as needed with no treatment. Moderate evidence showed fewer cases of preeclampsia in the treated group. The evidence was insufficient for maternal weight gain and birth injury. Moderate evidence found less shoulder dystocia with treatment for GDM. Low evidence showed no difference for neonatal hypoglycemia between treated and untreated GDM. Moderate evidence showed benefits of treatment for reduction of macrosomia (>4,000 g). There was insufficient evidence for long-term metabolic outcomes among offspring. Five studies provided data on harms of treating GDM. No difference was found for cesarean delivery, induction of labor, small for gestational age, or admission to a neonatal intensive care unit. There were significantly more prenatal visits among those treated. CONCLUSIONS: While evidence supports a positive association with increasing plasma glucose on a 75 g or 100 g oral glucose tolerance test and macrosomia and primary cesarean section, clear thresholds for increased risk were not found. The 50 g oral glucose challenge test has high NPV but variable PPV. Treatment of GDM results in less preeclampsia and macrosomia. Current evidence does not show that treatment of GDM has an effect on neonatal hypoglycemia or future poor metabolic outcomes. There is little evidence of short-term harm from treating GDM other than an increased demand for services. Research is needed on the long-term metabolic outcome for offspring as a result of GDM and its treatment, and the "real world" effects of GDM treatment on use of care.
Book Synopsis Novelties in Diabetes by : C. Stettler
Download or read book Novelties in Diabetes written by C. Stettler and published by Karger Medical and Scientific Publishers. This book was released on 2016-01-27 with total page 234 pages. Available in PDF, EPUB and Kindle. Book excerpt: The field of diabetes mellitus research is currently characterized by rapid and remarkable growth that has led to the development of significant diagnostic and therapeutic advances. This is very important given the fact that the frequency of the disease continues to increase at alarming rates worldwide. This new volume is a comprehensive overview of the contemporary state of the art in the field. Experts shed light on a broad range of relevant aspects, from genetic background to topics related to diabetic complications such as diabetic retinopathy or diabetic nephropathy. This is expanded upon through papers reporting on the present state of diabetes in pregnancy and on the relationship between diabetes and cancer. There is also an inventory of currently used therapeutic tools and a review of novel therapeutic approaches like incretin-based therapies or sodium-glucose transporter-2 inhibitors. Additionally, the latest technological developments such as enhanced features for blood glucose meter or continuous and implantable glucose monitoring devices are included. Providing a concise but comprehensive update, this book will be essential to every clinician involved in the treatment of diabetes mellitus.
Book Synopsis Gestational Diabetes During and After Pregnancy by : Catherine Kim
Download or read book Gestational Diabetes During and After Pregnancy written by Catherine Kim and published by Springer Science & Business Media. This book was released on 2014-01-02 with total page 381 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gestational Diabetes Mellitus is becoming an increasingly prevalent disease as obesity and other chronic diseases are on the rise. It requires careful and informed clinical management as the care received during pregnancy affects not only perinatal health but the risk of developing type 2 diabetes even decades into the future, in both the mother and the child.From epidemiology and pathophysiology to diagnosis and management, covering recent breakthroughs in research and up-to-date developments in clinical practice, Gestational Diabetes During and After Pregnancy offers the reader a comprehensive and current look at Gestational Diabetes. Anyone involved in the research, public health or clinical aspects of Gestational Diabetes will find this volume a valuable aid in consolidating all recent developments regarding this disease.
Book Synopsis Practical Guide to Oral Exams in Obstetrics and Gynecology by : Görker Sel
Download or read book Practical Guide to Oral Exams in Obstetrics and Gynecology written by Görker Sel and published by Springer Nature. This book was released on 2019-11-13 with total page 319 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book, based on non-interactive question-and-answer format, offers an essential guide for medical students who need to prepare for oral exams or clinical visits. Starting from specific clinical situations the volume provides clear questions on the theory related to the cases. Each question is followed by correct answers that summarize the main information. Suggested reading are included to deepen the topics and enhance the readers knowledge. Accordingly, this practical guide will help students get ready for their oral exams, and help prepare young residents for their first clinical cases.
Book Synopsis Gestational Diabetes: from Diagnosis to Treatment by : Hasan Aydin
Download or read book Gestational Diabetes: from Diagnosis to Treatment written by Hasan Aydin and published by Nova Science Publishers. This book was released on 2020-10-09 with total page 648 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gestational diabetes, because of its not only high prevalence but also resulting complications in both mother and fetus makes it one of the most important problem of a pregnant woman. The exact cause of gestational diabetes is unknown. Obviously, there is no one reason for the development of the disease. Placental hormones likely play a role. Insulin resistance is in the center and some factors like adipokines, lipids, inflammation, oxidative stress, heavy metals, gut microbiota, autoimmunity, metabolomics, genetic factors and vitamin D are the determinants for the development of insulin resistance and disease itself.Worldwide distribution of the disease changes according to geography. Ethnic factors also play role. Although some well-known risk factors have role in the development of the disease, 1 in 20 women without any risk factors also develop GDM. There is no universal screening and diagnostic methods. Some countries use universal screening some others prefer selective screening of women with risk factors. In addition, some suggest use of one-step diagnosis, while others two-step. The most challenging issue is use of some biomarkers in early (first trimester) diagnosis of pregnancy to prevent development of GDM. Many modalities are used in treatment. Medical nutrition therapy is still the basis of management. Exercise has some roles, too. Besides pharmacotherapies like insulin and oral antidiabetics, some modern modalities like insulin pump therapy together with continuous glucose monitoring, telemedicine, dietary supplements like myoinositols are also covered in this book. Monitorization is important in diabetes and role of nurses in follow-up is incontrovertible. If not treated well, both fetus and mother are open to complications. From congenital malformations to macrosomia, if inevitable, proper management of these problems has to be considered. Some comorbidities like hypertension, thyroid problems and psychosocial stress complicate the problem further. Fetal monitorization, time and type of delivery and management of glycaemia during peripartum period are the issues to be considered towards to end of pregnancy.The problem does not finish with the birth of baby. Both mother and newborn has to be followed for the development of future problems like postpartum diabetes and obesity. Nutrition and benefits of breastfeeding are important points for the health of the baby. In addition, every efforts has to be spent to prevent recurrence of the disease in subsequent pregnancies.The most important instrument against fighting a disease is information i.e. how much we know about it. Understanding the problem thoroughly strengthens our hands to cope and overcome it more easily. The main target of this book is to handle every aspect of the disease from diagnosis to treatment as evident from the title. It is a candidate for a reference guide in this subject. It includes most recent and update data on gestational diabetes.
Book Synopsis Quick Hits in Obstetric Anesthesia by : Roshan Fernando
Download or read book Quick Hits in Obstetric Anesthesia written by Roshan Fernando and published by Springer Nature. This book was released on 2022-02-07 with total page 500 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides easy to follow guidance on how to manage emergency situations and common problems in obstetric anesthesia. The book provides different anesthetic recipes for obstetric procedures and describes challenges that will be encountered on a day-to-day basis. There are trouble-shooting chapters and ‘what to do lists’ for frequent dilemmas. The book covers obstetric-specific resuscitation and medical emergencies seen on the labor ward. Antenatal and postpartum complications relating to anesthesia are covered as well as issues that may arise during follow up of patients who have had neuraxial anesthesia during delivery. Quick Hits in Obstetric Anesthesia should be used as a cognitive aid for emergency cases and as a decision-making tool for urgent management plans. It is a guide to common problems and provides core knowledge to facilitate anesthesia care on labor wards for all grades of anesthetist.
Book Synopsis Screening and Diagnosing Gestational Diabetes Mellitus by :
Download or read book Screening and Diagnosing Gestational Diabetes Mellitus written by and published by . This book was released on 2012 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Prevention of Type 2 Diabetes by : Manfred Ganz
Download or read book Prevention of Type 2 Diabetes written by Manfred Ganz and published by John Wiley & Sons. This book was released on 2005-09-01 with total page 376 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a unique and comprehensive synopsis of the prevention and early diagnosis of Type 2 Diabetes. It features articles by key opinion leaders in diabetes from North America, Europe and the Asia-Pacific region who describe the gravity of the problem and the important issue of screening, including contributions on the perspectives of the International Diabetes Federation and the World Health Organization. Once patients at risk have been identified, the key issue is to prevent their progression to full-blown diabetes. Several chapters address this, particularly the difficult task of changing people’s behaviour. Prevention of the complications associated with diabetes involves more targeted interventions, which are discussed by experts in the relevant areas. This book offers both a global perspective and local solutions. Key contributors include Paul Zimmet and Pierre Lefèbvre, President of the International Diabetes Federation who has written a chapter and a foreword. Praise from the reviews: "[A]n excellent resource for professionals who want a good means for getting up to speed on the prevention angle. It is all-inclusive from many perspectives – authorship of chapters, rich reference lists, and content (...). This book is a one-stop source for understanding the state of current prevention knowledge about type 2 diabetes." —DIABETES TECHNOLOGY & THERAPEUTICS "This is a timely and helpful treatment of an important public health topic. I am unaware of any other contemporary books which address exactly this issue." —DOODY'S HEALTH SERVICES "An ambitious title, written by some of the world’s leading diabetologists, it takes a very careful approach ( ...)" —PEDIATRIC ENDOCRINOLOGY REVIEWS (PER)
Book Synopsis A Practical Manual of Diabetes in Pregnancy by : David McCance
Download or read book A Practical Manual of Diabetes in Pregnancy written by David McCance and published by John Wiley & Sons. This book was released on 2017-09-20 with total page 751 pages. Available in PDF, EPUB and Kindle. Book excerpt: A PRACTICAL MANUAL OF DIABETES IN PREGNANCY The second edition of A Practical Manual of Diabetes in Pregnancy offers a wealth of new evidence, new material, new technologies, and the most current approaches to care. With contributions from a team of international experts, the manual is highly accessible and comprehensive in scope. It covers topics ranging from preconception to postnatal care, details the risks associated with diabetic pregnancy, and the long-term implications for the mother and baby. The text also explores recent controversies and examines thorny political pressures. The manual’s treatment recommendations are based on the latest research to ensure pregnant women with diabetes receive the best possible care. The text takes a multi-disciplinary approach that reflects best practice in the treatment of diabetes in pregnancy. The revised second edition includes: New chapters on the very latest topics of interest Contributions from an international team of noted experts Practical, state-of-the-art text that has been fully revised with the latest in clinical guidance Easy-to-read, accessible format in two-color text design Illustrative case histories, practice points, and summary boxes, future directions, as well as pitfalls and what to avoid boxes Multiple choice questions with answers in each chapter Comprehensive and practical, the text is ideal for use in clinical settings for reference by all members of the multi-disciplinary team who care for pregnant women with diabetes. The manual is also designed for learning and review purposes by trainees in endocrinology, diabetes, and obstetrics.
Book Synopsis Mayo Clinic Guide to a Healthy Pregnancy by : Mayo Clinic
Download or read book Mayo Clinic Guide to a Healthy Pregnancy written by Mayo Clinic and published by Harper Collins. This book was released on 2009-03-17 with total page 628 pages. Available in PDF, EPUB and Kindle. Book excerpt: Book description to come.
Book Synopsis Type 2 Diabetes by : Anca Pantea Stoian
Download or read book Type 2 Diabetes written by Anca Pantea Stoian and published by BoD – Books on Demand. This book was released on 2021-09-22 with total page 442 pages. Available in PDF, EPUB and Kindle. Book excerpt: Diabetes mellitus is a metabolic disease characterized by chronic high blood glucose levels. Of the various types of diabetes, type 2 diabetes is increasing in prevalence due to obesity, aging, sedentarism, and other factors. This book presents a novel approach to preventing and treating type 2 diabetes. Chapters cover such topics as diagnosis, pathogenesis, management, lifestyle and nutritional intervention, and systems to support early diagnosis and prevention of prediabetes.
Book Synopsis Laboratory Diagnosis and Monitoring of Diabetes Mellitus by : P. -Kanagasabapathy A. -Reinauer H. C-Home Heuck
Download or read book Laboratory Diagnosis and Monitoring of Diabetes Mellitus written by P. -Kanagasabapathy A. -Reinauer H. C-Home Heuck and published by . This book was released on 2003-01-01 with total page 27 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper discusses the essential role of the laboratory in the diagnosis and management of diabetes mellitus.
Book Synopsis Low Glycemic Index Diet by : Janette Brand Miller
Download or read book Low Glycemic Index Diet written by Janette Brand Miller and published by . This book was released on 2008 with total page 296 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Low GI Diet is the only science-based diet that is proven to help you lose weight and develop a lifetime of healthy eating habits that can help you achieve optimum health and wellbeing and protect against illness and disease. This guide features: an effective 12-week action plan based on low GI eating, exercise, and activity goals for each week which will enable you to lose up to ten per cent of your current body weight; plus an ongoing maintenance program tips to help you maintain weight loss for life delicious recipes and meal plans the GI tables with the GI values of all your favourite foods. The result: A slimmer, fitter, healthier you for the rest of your life! Brought to you by the authors of the worldwide bestselling The New Glucose Revolution series on the glycemic index, The Low GI Diet explains how choosing low GI carbohydrates can help you feel fuller for longer and increase your energy levels making weight loss achievable and sustainable. A companion volume to the newly revised and updated The Low GI Handbook. Start losing weight and improving your overall health today.
Book Synopsis Williams Manual of Obstetrics by : Kenneth J. Leveno
Download or read book Williams Manual of Obstetrics written by Kenneth J. Leveno and published by McGraw-Hill Professional Publishing. This book was released on 2002 with total page 852 pages. Available in PDF, EPUB and Kindle. Book excerpt: This manual has been completely rewritten and reorganized for optimal quick reference, while still covering the key diagnostic and treatment guidelines from "Williams Obstetrics." Revised since the publication of its parent text, this book updates all references and guidelines, while incorporating the latest clinical trials. 100 illustrations.
Book Synopsis Screening for Gestational Diabetes Mellitus by : Jennifer Pillay
Download or read book Screening for Gestational Diabetes Mellitus written by Jennifer Pillay and published by . This book was released on 2021 with total page 453 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Gestational diabetes mellitus (GDM) is largely asymptomatic; screening for GDM during pregnancy could identify women who could benefit from treatments to reduce adverse consequences of GDM. PURPOSE: To systematically update the 2012 evidence review used to inform United States Preventive Services Task Force (USPSTF) recommendations on benefits and harms of screening for GDM. DATA SOURCES: MEDLINE, Embase, and CINAHL (2010 to May 2020), ClinicalTrials.gov, reference lists of primary studies and systematic reviews; with surveillance through June 2021. All previously reviewed studies were re-assessed for eligibility. STUDY SELECTION: Two investigators independently reviewed abstracts and full-text articles against a set of a priori inclusion criteria. Disagreements were resolved through discussion. We included English-language controlled trials for effectiveness of screening and treatment; observational studies on screening effectiveness and harms, diagnostic accuracy of screening tests and association between GDM and outcomes. DATA EXTRACTION: One investigator abstracted data and a second investigator checked data abstraction for completeness and accuracy. Two investigators independently rated quality of the included studies using design-specific criteria. DATA SYNTHESIS (RESULTS): Twenty trials (different screening strategies [N=27,196]; treatment benefits and harms [N=4,235]) and 87 observational studies (screening benefits [N=4,336] and harms [N=166,082]; diagnostic accuracy [N=91,260]; outcome associations [N=105,492]) were included. Four observational studies (N=4,336) of screening versus no screening suggested that screening may be associated with reduced risk of some pregnancy and neonatal outcomes, but findings for each outcome were based on single studies with methodological limitations. Undergoing screening or receiving a false positive result may not be associated with anxiety; GDM may be associated with unnecessary cesarean delivery. In five trials (N=25,772), 1-step International Association of Diabetes and Pregnancy Study Group (IADPSG) versus 2-step Carpenter-Coustan (CC) screening was associated with increased likelihood of gestational diabetes (11.5% vs 4.9%) but no improved health outcomes. One trial (n=922) suggested that early versus usual timing of 2-step CC screening may not improve outcomes in obese women. Forty-five studies (N=91,260) evaluated diagnostic accuracy. At 24 to 28 weeks' gestation, the oral glucose challenge test using 135 or 140 mg/dL thresholds, against CC and National Diabetes Data Group (NDDG) criteria, and a fasting plasma glucose of 85 mg/dL or 90 mg/dL against CC GDM, had reasonable accuracy (sensitivities ≥81% and specificities ≥73%). Screening with the glucose challenge test against IADPSG criteria had low sensitivity. Being diagnosed with GDM based on more (e.g., 1-step IADPSG) versus less (e.g., 2-step CC) inclusive criteria, but not treated, associated with increased risk of preeclampsia, cesarean deliveries, preterm deliveries, macrosomia, LGA, neonatal hypoglycemia, and hyperbilirubinemia. No association was found for NICU admissions. From nine trials (N=3,982), treatment for mild GDM at or after 24 weeks' gestation associated with decreased risk of primary cesarean deliveries (RR, 0.70 [95% CI, 0.54 to 0.91]; ARD, 5.3%), preterm deliveries (RR, 0.75 [95% CI, 0.56 to 1.01]; ARD 2.3%), preeclampsia (RR, 0.60 [95% CI, 0.35 to 1.01]; ARD, 1%; after excluding one outlier trial), shoulder dystocia (RR, 0.42 [95% CI, 0.23 to 0.77]; ARD, 1.3%), macrosomia by 8.9% (RR, 0.53 [95% CI, 0.41 to 0.68]; ARD, 8.9%), LGA (RR, 0.56 [95% CI, 0.47 to 0.66]; ARD, 8.4%), birth injuries (e.g., fracture or nerve palsies) (OR, 0.33 [95% CI, 0.11 to 0.99]; ARD, 0.2%) and NICU admissions (RR, 0.73 [95% CI, 0.53 to 0.99; ARD, 2.0%). There was no association with risk of neonatal hypoglycemia or total cesarean deliveries, or for the potential harm of small-for-gestational age. There was limited evidence on long-term health outcomes and for early versus usual timing of screening. LIMITATIONS: Evidence on screening versus no screening was observational; very limited evidence on early treatment; restricted to English language studies; unable to formally assess for publication bias; limited evidence for some comparisons and outcomes, and most subgroups; heterogeneity present in some analyses. CONCLUSIONS: While direct evidence on outcomes of screening remains very limited, screening tests can identify women with gestational diabetes at or after 24 weeks' gestation and treatment is associated with improvement in various maternal and neonatal outcomes without serious harms. One- versus 2-step screening was not associated with improved health outcomes. Research should clarify optimal timing of screening and if risk-based tools combined with glycemic measures are better predictors of GDM and treatment-responsive outcomes.
