Early Gestational Diabetes Screening Based on ACOG Guidelines

Abstract

Objective A recent randomized controlled trial suggested that early gestational diabetes mellitus (GDM) screening in patients with obesity (body mass index [BMI] ≥30 kg/m²) does not improve perinatal outcomes. The American College of Obstetrics and Gynecology currently recommends early screening for gestational diabetes in patients who are overweight with one or more additional risk factors. We evaluated the effect of screening based on the number of additional risk factors for development of gestational diabetes.

Study Design This was a secondary analysis of a multicenter randomized controlled trial of obese patients with singleton nonanomalous fetuses comparing early (14–20 weeks' gestation) with routine (24–28 weeks' gestation) GDM screening. Exclusion criteria were pregestational diabetes, major medical illnesses, bariatric surgery, chronic steroid use, and prior cesarean. Early versus routine GDM screening groups were compared and stratified by the number of additional risk factors for GDM (0, 1, 2, and ≥3). The primary outcome was an adverse perinatal composite outcome composed of: macrosomia, primary cesarean delivery, hypertensive disorders of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia. Analyses examined effects of early versus routine screening by the number of additional risk factors and their possible interaction on the incidences of the primary outcome and GDM.

Results Of 913 patients, 5% had 0, 52% had 1, 33% had 2, and 10% had ≥3 additional risk factors. Baseline characteristics, including the number and type of risk factors, were similar between early and routine screening groups. Breslow–Day test for interaction between early versus routine screening and the number of additional risk factors was not significant for either the primary outcome (p = 0.37) or the diagnosis of GDM (p = 0.28). The incidence of GDM and the adverse perinatal composite outcome increased as the number of risk factors increased (p < 0.001).

Conclusion In patients with BMI ≥30 kg/m² and additional risk factors, early GDM screening does not prevent adverse outcomes.

Key Points

• The ACOG currently recommends early screening for gestational diabetes if patients have risk factors.

• Even in patients with multiple risk factors, early screening for GDM does not improve outcomes.

• Patients with three or more risk factors may have worse outcomes if they undergo early screening.

Keywords

gestational diabetes - gestational diabetes screening - diabetes screening - early gestational diabetes

Note

All individuals who contributed to this work have met standard criteria for authorship.

This work was presented as an oral presentation for the Society for Maternal-Fetal Medicine's 40th Annual Pregnancy Meeting, February 5–8, 2020, in Dallas, TX.

Publication History

Received: 17 December 2021

Accepted: 11 August 2022

Accepted Manuscript online:
16 August 2022

Article published online:
29 December 2022

• References

• 1 American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 2004; 27 (01) 88-90
• 2 Shah NS, Wang MC, Freaney PM. et al. Trends in gestational diabetes at first live birth by race and ethnicity in the US, 2011-2019. JAMA 2021; 326 (07) 660-669
• 3 Bouthoorn SH, Silva LM, Murray SE. et al. Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study. Acta Diabetol 2015; 52 (03) 445-452
• 4 Chen P, Wang S, Ji J. et al. Risk factors and management of gestational diabetes. Cell Biochem Biophys 2015; 71 (02) 689-694
• 5 ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol 2018; 131 (02) e49-e64
• 6 ACOG Practice Bulletin No. 202: gestational hypertension and preeclampsia. Obstet Gynecol 2019; 133 (01) 1
• 7 Caughey AB, Cheng YW, Stotland NE, Washington AE, Escobar GJ. Maternal and paternal race/ethnicity are both associated with gestational diabetes. Am J Obstet Gynecol 2010; 202 (06) 616.e1-616.e5
• 8 Moyer VA. U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160 (06) 414-420
• 9 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33 (1, suppl 1): S62-S69
• 10 Harper LM, Jauk V, Longo S, Biggio JR, Szychowski JM, Tita AT. Early gestational diabetes screening in obese women: a randomized controlled trial. Am J Obstet Gynecol 2020; 222 (05) 495.e1-495.e8
• 11 Sokol RJ, Blackwell SC. American College of Obstetricians and Gynecologists. Committee on Practice Bulletins-Gynecology. ACOG practice bulletin: shoulder dystocia. Number 40, November 2002. (Replaces practice pattern number 7, October 1997). Int J Gynaecol Obstet 2003; 80 (01) 87-92
• 12 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114 (01) 297-316
• 13 Osmundson SS, Zhao BS, Kunz L. et al. First trimester hemoglobin A1c prediction of gestational diabetes. Am J Perinatol 2016; 33 (10) 977-982
• 14 Hong WY, Biggio JR, Tita A, Harper LM. Impact of early screening for gestational diabetes on perinatal outcomes in high-risk women. Am J Perinatol 2016; 33 (08) 758-764