title: Screening for gestational diabetes mellitus in primary versus secondary care: The clinical outcomes of a randomised controlled trial.
abstract: OBJECTIVE
  To examine the clinical outcomes of screening for gestational diabetes mellitus (GDM) in primary care versus secondary care, in the Irish healthcare system.
  
  
  METHODS
  A parallel group randomised controlled trial (RCT) of screening for GDM in primary versus secondary care was used to examine (i) prevalence, (ii) gestational week of screen, (iii) time to access specialist care, and (iv) maternal and neonatal outcomes. In total 781 women were recruited for screening in primary care (n=391) or secondary care (n=390).
  
  
  RESULTS
  The prevalence of GDM and gestational week of screen were similar in both locations. There was a trend towards a longer time to access diabetes care in primary care (24days) versus secondary care (19days), a difference of 5days (p=0.09). Women screened in primary care also showed a trend towards a higher rate of large for gestational age (LGA) infants (20%) than those screened in secondary care (14.7%), (p=0.09). There were no differences between groups in maternal outcomes.
  
  
  CONCLUSIONS
  This RCT suggests that screening for GDM in secondary care may be associated with potentially faster time to access specialist antenatal diabetes care and possibly lower LGA rates. Further research is needed to clarify these findings and to improve the delay in accessing specialist care requires an urgent focus. Further research is needed to test these findings in other health systems.
authors.affiliation: School of Medicine, National University of Ireland, Galway, Ireland. Electronic address: angelaodea@rcsi.ie.
authors.forename: Angela
authors.initials: A
authors.lastname: O'Dea
authors.affiliation: School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Marie
authors.initials: M
authors.lastname: Tierney
authors.affiliation: J.E. Cairnes School of Business & Economics, National University of Ireland, Galway, Ireland.
authors.forename: Andriy
authors.initials: A
authors.lastname: Danyliv
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland; Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
authors.forename: Liam G
authors.initials: LG
authors.lastname: Glynn
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland; School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Brian E
authors.initials: BE
authors.lastname: McGuire
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Carmody
authors.affiliation: HRB Clinical Research Facility, National University of Ireland, Galway, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Newell
authors.affiliation: School of Medicine, National University of Ireland, Galway, Ireland; Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
authors.forename: Fidelma P
authors.initials: FP
authors.lastname: Dunne
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005865:Gestational Age; D006801:Humans; D008403:Mass Screening; D011247:Pregnancy; D011320:Primary Health Care; D063127:Secondary Health Care
keywords: Clinical outcomes; GDM; Gestational diabetes mellitus; Primary care; Screening