The impact of universal screening for gestational glucose intolerance on outcome of pregnancy.
Universal screening for gestational glucose intolerance has strong support, despite the lack of scientific evidence documenting its benefit. In the early 1980s, practicing obstetricians were split concerning the clinical importance of gestational glucose intolerance, so that some practitioners tested virtually all the patients they treated while others tested none. This historical reality provided concurrent screened and unscreened populations in whom to assess the impact of screening. We studied all 1,307 singleton pregnancies cared for and delivered at the New York Hospital-Cornell University Medical Center during a five month period. Large infants (birth weight greater than or equal to 4,000 grams) were born to 10.5 per cent of the women who were not screened (533) and to 11.2 per cent of the women who were screened (774). The process of screening not only failed to decrease the rate of large infants, but also failed to improve otherwise pregnancy outcomes and was associated with more intensive surveillance during pregnancy and a significantly higher rate of primary cesarean delivery. Given the unexpected concomitants of the screening process, we conclude that recommendations for universal screening for gestational glucose intolerance should be reconsidered.
Santini
D L
DL
Department of Medicine, New York Hospital-Cornell University Medical Center, New York 10021.
Ales
K L
KL
D000328:Adult; D000704:Analysis of Variance; D001724:Birth Weight; D002585:Cesarean Section; D015331:Cohort Studies; D005069:Evaluation Studies as Topic; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis; D007231:Infant, Newborn; D008403:Mass Screening / Q000379:methods*; D009765:Obesity / Q000150:complications; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011295:Prenatal Care; D011336:Probability; D012044:Regression Analysis; D012189:Retrospective Studies