Early vs. standard screening and treatment of gestational diabetes in high-risk women – An attempt to determine relative advantages and disadvantages

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2019-06, Vol.29 (6), p.598-603
• Main Authors: Bianchi, C., de Gennaro, G., Romano, M., Battini, L., Aragona, M., Corfini, M., Del Prato, S., Bertolotto, A.
• Format: Article
• Language: English
• Subjects: Adult; Diabetes, Gestational - blood; Diabetes, Gestational - diagnosis; Diabetes, Gestational - drug therapy; Diabetes, Gestational - epidemiology; Early Diagnosis; Early Medical Intervention; Early screening; Female; Gestational diabetes; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Italy - epidemiology; Mass Screening; Maternal and fetal outcomes; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Prenatal Care - methods; Prevalence; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2019.02.007

Screening for Gestational Diabetes (GDM) is usually recommended between 24 and 28 weeks of pregnancy; however available evidence suggests that GDM may be already present before recommended time for screening, in particular among high-risk women as those with prior GDM or obesity. The purpose of this retrospective study was to evaluate whether early screening (16–18 weeks) and treatment of GDM may improve maternal and fetal outcomes. In 290 women at high-risk for GDM, we analyzed maternal and fetal outcomes, according to early or standard screening and GDM diagnosis time. Early screening was performed by 50% of high-risk women. The prevalence of GDM was 62%. Among those who underwent early screened, GDM was diagnosed at the first evaluation in 42.7%. Women with early diagnosis were more frequently treated with insulin and had a slightly lower HbA1c than women with who were diagnosed late. No differences were observed in the prevalence of Cesarean section, operative delivery, gestational age at the delivery, macrosomia, neonatal weight, Ponderal Index and Large-for-Gestational-Age among women with early or late GDM diagnosis or NGT. However, compared to NGT women, GDM women, irrespective of the time of diagnosis, had a lower gestational weight gain, lower prevalence of macrosomia (3.9% vs. 11.4%), small (1.7% vs. 8.3%) as well as large for gestational age (3.3% vs. 16.7%), but higher prevalence of pre-term delivery (8.9% vs. 2.7%). Early vs. standard screening and treatment of GDM in high-risk women is associated with similar short-term maternal-fetal outcomes, although women with an early diagnosis were treated to a greater extent with insulin therapy. •Early vs. standard screening and treatment of GDM in high-risk women leads to similar short-term maternal-fetal outcomes.•Women with an early diagnosis were treated to a greater extent with insulin therapy.•NGT high-risk women gained more weight during pregnancy than those with GDM.•NGT high-risk women had worsen fetal outcomes than those with GDM.