title: Screening and subsequent management for gestational diabetes for improving maternal and infant health.
abstract: BACKGROUND
  Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mother and baby both perinatally and in the long term. There is strong evidence to support treatment for GDM. However, there is little consensus on whether or not screening for GDM will improve maternal and infant health and if so, the most appropriate protocol to follow.
  
  
  OBJECTIVE
  To assess the effects of different methods of screening for GDM and maternal and infant outcomes.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013).
  
  
  METHODS
  Randomised and quasi-randomised trials evaluating the effects of different methods of screening for GDM.
  
  
  METHODS
  Two review authors independently conducted data extraction and quality assessment. We resolved disagreements through discussion or through a third author.
  
  
  RESULTS
  We included four trials involving 3972 women in the review. One quasi-randomised trial compared risk factor screening with universal or routine screening by 50 g oral glucose challenge testing. Women in the universal screening group were more likely to be diagnosed with GDM (one trial, 3152 women, risk ratio (RR) 0.44, 95% confidence interval (CI) 0.26 to 0.75). This trial did not report on the other primary outcomes of the review (positive screen for GDM, mode of birth, large-for-gestational age, or macrosomia). Considering secondary outcomes, infants of mothers in the risk factor screening group were born marginally earlier than infants of mothers in the routine screening group (one trial, 3152 women, mean difference (MD) -0.15 weeks, 95% CI -0.27 to -0.03).The remaining three trials evaluated different methods of administering a 50 g glucose load. Two small trials compared glucose monomer with glucose polymer testing, with one of these trials including a candy bar group. One trial compared a glucose solution with food. No differences in diagnosis of GDM were found between each comparison. However, in one trial significantly more women in the glucose monomer group screened positive for GDM than women in the candy bar group (80 women, RR 3.49, 95% CI 1.05 to 11.57). The three trials did not report on the primary review outcomes of mode of birth, large-for-gestational age or macrosomia. Overall, women drinking the glucose monomer experienced fewer side effects from testing than women drinking the glucose polymer (two trials, 151 women, RR 2.80, 95% CI 1.10 to 7.13). However, we observed substantial heterogeneity between the trials for this result (I² = 61%).
  
  
  CONCLUSIONS
  There was insufficient evidence to determine if screening for gestational diabetes, or what types of screening, can improve maternal and infant health outcomes.
authors: ARCH: Australian Research Centre for Health of Women and Babies, The Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 1st floor, Queen Victoria Building, 72 King William Road, Adelaide, South Australia, Australia, 5006.
authors: Joanna
authors: J
authors: Tieu
authors: Andrew J
authors: AJ
authors: McPhee
authors: Caroline A
authors: CA
authors: Crowther
authors: Philippa
authors: P
authors: Middleton
mesh_terms: D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005951:Glucose Tolerance Test / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007229:Infant Welfare; D007231:Infant, Newborn; D008403:Mass Screening / Q000379:methods*; D008429:Maternal Welfare; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic