Time to Completion of Two-Step Screening for Gestational Diabetes and Adverse Outcomes

Abstract

Objective This study aimed to ascertain whether the length of time to complete the gestational diabetes mellitus (GDM) screening was associated with adverse neonatal outcomes.

Study Design This was a retrospective cohort study of singleton, nonanomalous individuals who were screened for GDM at ≥24 weeks' gestation at an academic hospital system. We compared outcomes among people who were diagnosed with GDM and completed the 3-hour glucose tolerance test (GTT) ≤14 second versus >14 days from the 1-hour glucose challenge test (GCT). The primary outcome was a composite adverse neonatal outcome of the following: large for gestational age, shoulder dystocia, birth injury, respiratory distress, hypoglycemia, or fetal/neonatal death. The secondary outcomes included several individual neonatal and maternal morbidities. Multivariable Poisson's regression models were used to evaluate the association. Adjusted relative risk (aRR) and 95% confidence intervals (CI) were calculated.

Results Among the 313 individuals who completed the two-step screening for GDM and had an 1-hour GCT ≥ 135 mg/dL; of them, 171 (54.6%) completed the 3-hour GTT ≤14 days, 142 (45.4%) completed the 3-hour GTT > 14 days. Overall rate of the primary outcome was 44.1%. After multivariable adjustment, the risk of the primary outcome was similar between people who completed the two-step method in ≤14 versus >14 days (aRR = 1.11, 95% CI = 0.81–1.52). There was no significant difference in all secondary adverse outcomes between the two groups. Subgroup analyses, limited to people diagnosed with GDM (N = 89, 23.4%), also found similar results as the full analyses.

Conclusion Among individuals who completed the two-step screening for GDM, completion of the 3-hour GTT within ≤14 versus ≥ 14 days was not associated with an increase rate of the adverse outcomes.

Key Points

• Among pregnant people in an academic practice, 50% of people with abnormal 1-hour GTT completed GDM two-step screening in 14 days.

• Longer length of time to completion of diagnostic testing for GDM was not associated with an increased rate of adverse outcomes.

• Pregnant people that were diagnosed with GDM and completed the two-step method in >14 days did not have worse perinatal outcomes.

Keywords

gestational diabetes - screening - glucose tolerance test - large for gestational age

Publikationsverlauf

Eingereicht: 24. Januar 2023

Angenommen: 31. Juli 2023

Accepted Manuscript online:
01. August 2023

Artikel online veröffentlicht:
15. September 2023

• References

• 1 Gregory E, Ely DM. Trends and Characteristics in Gestational Diabetes: United States, 2016–2020, in National Vital Statistics Reports, Vol. 71. 2022
• 2 Landon MB, Spong CY, Thom E. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361 (14) 1339-1348
• 3 Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352 (24) 2477-2486
• 4 Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med 2013; 159 (02) 123-129
• 5 Shah NS, Wang MC, Freaney PM. et al. Trends in gestational diabetes at first live birth by race and ethnicity in the US, 2011-2019. JAMA 2021; 326 (07) 660-669
• 6 Metzger BE, Lowe LP, Dyer AR. et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358 (19) 1991-2002
• 7 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373 (9677) 1773-1779
• 8 Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002; 25 (10) 1862-1868
• 9 Bochkur Dratver MA. et al. Longitudinal changes in glucose during pregnancy in women with gestational diabetes risk factors. Diabetologia 2021
• 10 Association AD. American Diabetes Association. 14. Management of diabetes in pregnancy: standards of medical care in diabetes-2020. . Diabetes Care 2020; 43 (Suppl. 01) S183-S192
• 11 Sohn J, Lim HJ, Kim S. et al. Delayed diagnosis of gestational diabetes mellitus and perinatal outcomes in women with large for gestational age fetuses during the third trimester. Obstet Gynecol Sci 2020; 63 (05) 615-622
• 12 Practice Bulletin No. Practice bulletin no. 180: gestational diabetes mellitus. Obstet Gynecol 2017; 130 (01) e17-e37
• 13 Moyer VA. U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160 (06) 414-420
• 14 Harper LM, Mele L, Landon MB. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Carpenter-Coustan compared with national diabetes data group criteria for diagnosing gestational diabetes. Obstet Gynecol 2016; 127 (05) 893-898
• 15 Bimson BE, Rosenn BM, Morris SA, Sasso EB, Schwartz RA, Brustman LE. Current trends in the diagnosis and management of gestational diabetes mellitus in the United States. J Matern Fetal Neonatal Med 2017; 30 (21) 2607-2612
• 16 Agarwal MM. Gestational diabetes mellitus: screening with fasting plasma glucose. World J Diabetes 2016; 7 (14) 279-289
• 17 Duryea EL, Hawkins JS, McIntire DD, Casey BM, Leveno KJ. A revised birth weight reference for the United States. Obstet Gynecol 2014; 124 (01) 16-22
• 18 Gestational Hypertension and Preeclampsia. Gestational hypertension and preeclampsia: ACOG practice bulletin summary, number 222. Obstet Gynecol 2020; 135 (06) 1492-1495
• 19 Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth 2014; 14: 41
• 20 Lachmann EH, Fox RA, Dennison RA, Usher-Smith JA, Meek CL, Aiken CE. Barriers to completing oral glucose tolerance testing in women at risk of gestational diabetes. Diabet Med 2020; 37 (09) 1482-1489
• 21 Edwards T, Harding JE. Clinical aspects of neonatal hypoglycemia: a mini review. Front Pediatr 2021; 8: 562251
• 22 Braun D, Braun E, Chiu V. et al. Trends in neonatal intensive care unit utilization in a large integrated health care system. JAMA Netw Open 2020; 3 (06) e205239
• 23 ACOG Practice Bulletin No. ACOG practice bulletin no. 190: gestational diabetes mellitus. Obstet Gynecol 2018; 131 (02) e49-e64
• 24 Hamilton BE, Martin JA, Osterman MJK. Births: provisional data for 2021. Vital Statistics Rapid Release no 20. Hyattsville, MD: National Center for Health Statistics. ; May 2022
• 25 Vandorsten JP, Dodson WC, Espeland MA. et al. NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements 2013; 29 (01) 1-31