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One-Step Approach IDs More Cases of Gestational Diabetes

THURSDAY, March 11, 2021 -- A one-step approach identifies more diagnoses of gestational diabetes, with no significant impact on perinatal or maternal complications, according to a study published in the March 11 issue of the New England Journal of Medicine.

Teresa A. Hillier, M.D., from Kaiser Permanente Northwest in Portland, Oregon, and colleagues performed a pragmatic, randomized trial comparing one-step screening (blood glucose level obtained after oral administration of a 75-g glucose load in fasting state) to two-step screening (blood glucose level obtained after oral administration of 50-g glucose load in nonfasting state followed by oral glucose-tolerance test with 100-g glucose load in fasting state) for pregnant women. A total of 23,792 women were randomly assigned to one-step or two-step screening; 66 percent in the one-step group and 92 percent in the two-step group adhered to assigned screening.

The researchers found that gestational diabetes was diagnosed in 16.5 and 8.5 percent of women assigned to the one- and two-step approaches, respectively (unadjusted relative risk, 1.94). In intention-to-treat analyses, the incidence of other primary outcomes did not differ significantly between the groups: large-for-gestational-age infants, 8.9 versus 9.2 percent; perinatal composite outcome, 3.1 versus 3.0 percent; gestational hypertension or preeclampsia, 13.6 versus 13.5 percent; and primary cesarean section, 24.0 versus 24.6 percent.

"The current trial provides robust evidence that single-step, as compared with two-step, gestational diabetes screening resulted in the detection of gestational diabetes in almost one in five pregnant women, with no apparent maternal or perinatal benefit overall," writes the author of an accompanying editorial.

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