Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Nov 1;140(5):712-723.
doi: 10.1097/AOG.0000000000004943. Epub 2022 Oct 5.

One-Step Compared With Two-Step Gestational Diabetes Screening and Pregnancy Outcomes: A Systematic Review and Meta-analysis

Matthew Brady  1 , Drew M Hensel, Rachel Paul, Michelle M Doering, Jeannie C Kelly, Antonina I Frolova, Anthony O Odibo, Valene Garr Barry, Camille E Powe, Nandini Raghuraman, Methodius G Tuuli, Ebony B Carter
Affiliations
Meta-Analysis

One-Step Compared With Two-Step Gestational Diabetes Screening and Pregnancy Outcomes: A Systematic Review and Meta-analysis

Matthew Brady et al. Obstet Gynecol. .

Abstract

Objective: To estimate short-term maternal and neonatal outcomes with one-compared with two-step testing for gestational diabetes mellitus (GDM).

Data sources: A systematic review of randomized controlled trials (RCTs) and observational studies comparing one-step and two-step GDM testing strategies before September 2021 was conducted. We searched Ovid Medline (1946-), EMBASE (1947-), Scopus (1960-), Cochrane Central, and ClinicalTrials.gov . The primary outcome was rate of large-for-gestational age (LGA) neonates. Secondary outcomes were clinically relevant outcomes for GDM that were selected a priori.

Methods of study selection: Titles, abstracts, and manuscripts were screened, selected, and reviewed by the first two authors. Four RCTs (24,966 patients) and 13 observational studies (710,677 patients) were analyzed.

Tabulation, integration, and results: Pooled relative risks (RRs) were calculated with 95% CIs using random-effects models and were plotted graphically with forest plots. Study heterogeneity was evaluated using Cochran Q and Higgins I 2 tests. The quality of studies that met the inclusion criteria was evaluated with the Downs and Black checklist. Publication bias was assessed by using asymmetry of funnel plots and Harbord's test. There was no difference in the rate of LGA neonates (pooled RR 0.95; 95% CI 0.88-1.04) by testing strategy among RCTs, but patients who underwent one-step testing were more likely to be diagnosed with GDM (pooled RR 2.13; 95% CI 1.61-2.82) and treated with diabetes medications (pooled RR 2.24; 95% CI 1.21-4.15). One-step testing was associated with higher rates of neonatal intensive care unit (NICU) admission (pooled RR 1.12; 95% CI 1.00-1.26) and neonatal hypoglycemia (pooled RR 1.23; 95% CI 1.13-1.34). In analysis of high-quality RCTs and observational studies, one-step testing was associated with a lower rate of LGA neonates (pooled RR 0.97; 95% CI 0.95-0.98), but higher rates of GDM diagnosis, treatment, NICU admission, and neonatal hypoglycemia.

Conclusion: Despite a significant increase in GDM diagnosis and treatment with one-step testing, there is no difference in rate of LGA neonates compared with two-step testing among RCTs.

Systematic review registration: PROSPERO, CRD42021252703.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure Jeannie C. Kelly reports that money was paid to her institution from PEW, the Barnes Jewish Foundation, and Doris Duke. Ebony Carter's institution received payment from the American Diabetes Association NIH/NIMH Robert Wood Johnson Foundation. She received payment as part of Carter Expert Strategic Consulting and from Affinia Healthcare (board advisor, Mother Goose). The other authors did not report any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Flowchart showing the methodology of study selection
Figure 2.
Figure 2.
Forest plot comparing one-step and two-step testing on LGA diagnosis, RCT
Figure 3.
Figure 3.
Forest plot comparing one-step and two-step testing on LGA diagnosis, High-quality studies
Figure 4.
Figure 4.
Forest plot comparing one-step and two-step testing on LGA diagnosis, Observational studies
Figure 5.
Figure 5.
Funnel plot comparing one-step and two-step testing on LGA diagnosis, RCTs and High-quality Observational studies X= Khalifeh et al (2020) RCT was not deemed high quality but was added to illustrate all RCTs included in the primary analysis * Of note, only three out of four Observational studies deemed high-quality reported rates of LGA. Two of the included studies are overlapping at the apex of the graph.
See this image and copyright information in PMC

Comment in

  • More Is Not Always Better.
    Ludgin J, Werner E. Ludgin J, et al. Obstet Gynecol. 2022 Nov 1;140(5):710-711. doi: 10.1097/AOG.0000000000004973. Epub 2022 Oct 5. Obstet Gynecol. 2022. PMID: 36201775 No abstract available.

References

    1. HAPO Study Cooperative Research Group. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Int J Gynaecol Obstet. Jul 2002;78(1):69–77. doi:10.1016/s0020-7292(02)00092-9 - DOI - PubMed
    1. Farrar D, Duley L, Dowswell T, Lawlor DA. Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database Syst Rev. 08 23 2017;8:CD007122. doi:10.1002/14651858.CD007122.pub4 - DOI - PMC - PubMed
    1. Davis EM, Abebe KZ, Simhan HN, et al. Perinatal Outcomes of Two Screening Strategies for Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstet Gynecol. 07 01 2021;138(1):6–15. doi:10.1097/AOG.0000000000004431 - DOI - PMC - PubMed
    1. Hillier TA, Pedula KL, Ogasawara KK, et al. A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening. New England Journal of Medicine. 2021;384(10):895–904. doi:10.1056/NEJMoa2026028 - DOI - PMC - PubMed
    1. Arya S, Kaji AH, Boermeester MA. PRISMA Reporting Guidelines for Meta-analyses and Systematic Reviews. JAMA Surgery. 2021;156(8):789–790. doi:10.1001/jamasurg.2021.0546 - DOI - PubMed

Publication types