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

Related ObG Topics:

Updated ACOG Guidance on Gestational Diabetes

What Is The ‘One-Step’ GDM Screening Approach?

Screening for Gestational Diabetes: The ‘2 Step’ Approach

Does Exercise in Pregnancy Decrease Risk of Gestational Diabetes?