Early Gestational Diabetes Screening in Obese Women: A Randomized Controlled Trial
Abstract
Background: Although in 2013 the American College of Obstetricians and Gynecologists recommended early screening for gestational diabetes in obese women, no studies demonstrate an improvement in perinatal outcomes with this strategy. Objective: We sought to determine if early screening for gestational diabetes improves perinatal outcomes in obese women. Study Design: Randomized controlled trial comparing early gestational diabetes screening (14–20 weeks) to routine screening (24–28 weeks) in obese women (BMI≥30 kg/m2) at two tertiary care centers in the US. Screening was performed using a 50-g, 1-hr glucose challenge test followed by a 100-g, 3-hr glucose tolerance test if initial screen ≥135 mg/dL. Gestational diabetes was diagnosed using Carpenter-Coustan criteria. Women not diagnosed at 14–20 wks were rescreened at 24–28 wks. Exclusion criteria were pre-existing diabetes, major medical illness, bariatric surgery, and prior cesarean. The primary outcome was a composite of macrosomia (>4000g), primary cesarean, hypertensive disease of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia (assessed within 48 hours of birth). Results: A total of 962 women were randomized, and outcomes were available for 922. Of these 922, 459 (49.8%) to early screen and 463 (50.2%) to routine screen. Baseline characteristics were balanced between groups. In the early screening group, 69 (15.0%, 95% CI 11.9–18.6%) were diagnosed with gestational diabetes: 29…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 962 participants or records.
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