Screening for gestational diabetes: variation in guidelines.
OBJECTIVE
To compare published guidelines concerning screening for gestational diabetes.


METHODS
Systematic search and comparative analysis of published guidelines. Appraisal of guidelines quality. Simulation analysis.


RESULTS
Ten published guidelines proposed either universal screening (5), selective screening (3) or screening when clinically indicated (2). Variations of testing schedules and blood glucose thresholds were observed. The quality of the published guidelines was low, on average 22 (8-51) percentage points on the assessment scale. These differences would have led to large variations in the number of patients to be screened.


CONCLUSIONS
Large variations between guidelines have been observed which would translate in large practice variations, if the guidelines were systematically applied. These variations are partially explained by the absence of definite evidence that universal or selective screening for gestational diabetes do more good than harm on infant and maternal health. The methodology of developing guidelines should be more evidence based, systematic and explicit.
Vogel
N
N
Institut universitaire de médecine sociale et préventive, Lausanne, Switzerland.
Burnand
B
B
Vial
Y
Y
Ruiz
J
J
Paccaud
F
F
Hohlfeld
P
P
D000328:Adult; D016640:Diabetes, Gestational / Q000150:complications / Q000175:diagnosis*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008423:Maternal Age; D009765:Obesity / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications; D017584:Reproductive History; D012307:Risk Factors