One step versus two step approach for gestational diabetes screening: systematic review and meta-analysis of the randomized trials

• Published in: The journal of maternal-fetal & neonatal medicine 2019-05, Vol.32 (9), p.1547-1555
• Main Authors: Saccone, Gabriele, Caissutti, Claudia, Khalifeh, Adeeb, Meltzer, Sara, Scifres, Christina, Simhan, Hyagriv N., Kelekci, Sefa, Sevket, Osman, Berghella, Vincenzo
• Format: Article
• Language: English
• Subjects: Diabetes; gestational diabetes mellitus; insulin; obesity
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2017.1408068

Introduction: To compare both the prevalence of gestational diabetes mellitus (GDM) as well as maternal and neonatal outcomes by either the one-step or the two-step approaches. Material and methods: Electronic databases were searched from their inception until June 2017. We included all randomized controlled trials (RCTs) comparing the one-step with the two-step approaches for the screening and diagnosis of GDM. The primary outcome was the incidence of GDM. Results: Three RCTs (n = 2333 participants) were included in the meta-analysis. 910 were randomized to the one step approach (75 g, 2 hrs), and 1423 to the two step approach. No significant difference in the incidence of GDM was found comparing the one step versus the two step approaches (8.4 versus 4.3%; relative risk (RR) 1.64, 95%CI 0.77-3.48). Women screened with the one step approach had a significantly lower risk of preterm birth (PTB) (3.7 versus 7.6%; RR 0.49, 95%CI 0.27-0.88), cesarean delivery (16.3 versus 22.0%; RR 0.74, 95%CI 0.56-0.99), macrosomia (2.9 versus 6.9%; RR 0.43, 95%CI 0.22-0.82), neonatal hypoglycemia (1.7 versus 4.5%; RR 0.38, 95%CI 0.16-0.90), and admission to neonatal intensive care unit (NICU) (4.4 versus 9.0%; RR 0.49, 95%CI 0.29-0.84), compared to those randomized to screening with the two step approach. Conclusions: The one and the two step approaches were not associated with a significant difference in the incidence of GDM. However, the one step approach was associated with better maternal and perinatal outcomes.