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Grand Rounds

One Step or Two Step GDM Screening – Comparing Outcomes

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BACKGROUND AND PURPOSE: 

  • There are two different GDM screening strategies available – the ‘one step’ International Association of the Diabetes and Pregnancy Study Groups (IADPSG) approach, and the ‘two step’ approach (Carpenter-Coustan) 
  • Palatnik et al. (Obstetrics & Gynecology, 2017) compared the rates of cesarean section during two separate clinical ‘epochs’ – the first using IADPSG followed by Carpenter-Coustan

METHODS: 

  • Retrospective Cohort study (2010 – 2015) 
  • Subjects were screened for GDM with either
    • ‘One step’ IADPSG  
    • ‘Two step’ Carpenter-Coustan   
  • ‘One step’ was used from Dec 2010 – July 2013, at which point protocol was changed to the two step approach based on the NIH Consensus Conference (2013) 
  • The primary outcome was rate of necessary cesarean section 
  • Secondary outcomes  
    • Shoulder dystocia 
    • NICU admission 
    • Hypertensive disease of pregnancy

RESULTS: 

  • Data included 23 509 women 
  • Compared to Carpenter-Coustan epoch, the IADPSG epoch had  
    • Higher incidence of GDM diagnosis (8.3% vs 7.5%, P=.042) 
    • Higher total cesarean section rate (27.0% vs 25.5% P=.022) 
    • Higher primary cesarean rate (19.1% vs 18.0%, P=.041) 
    • Increased shoulder dystocia rates (2.5% vs 2.1%, P=.043) 
    • Increased NICU admission (3.2% vs 2.0%, P<.001) 
    • Decreased hypertensive disease in pregnancy (6.9% vs 7.7%, P=.018) 
  • Subgroup analysis of the rates of total and primary cesarean delivery among women with GDM did not differ between the two screening epochs 
  • There was no difference in rates of LGA, postpartum hemorrhage, neonatal respiratory distress syndrome, neonatal hypoglycemia, neonatal hyperbilirubinemia, and perinatal death 

CONCLUSION: 

  • GDM diagnosis may affect decision-making regarding the route of delivery, as LGA was not different between the two different screening periods  
  • Authors recommend RTCs before new testing strategies are implemented 

Learn More – Primary Sources:  

Association Between Type of Screening for Gestational Diabetes Mellitus and Cesarean Delivery

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Related ObG Topics:

Updated ACOG Guidance on Gestational Diabetes
Practical obstetrics info for your women's healthcare practice
What Is The ‘One-Step’ GDM Screening Approach?
Practical obstetrics info for your women's healthcare practice
Screening for Gestational Diabetes: The ‘2 Step’ Approach
Does Exercise in Pregnancy Decrease Risk of Gestational Diabetes?

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