#Grand Rounds

One Step or Two Step GDM Screening – Comparing Outcomes

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

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

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

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

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