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Systematic review and meta‐analysis of diagnosing gestational diabetes mellitus with one‐step or two‐step approaches and associations with adverse pregnancy outcomes
Author(s) -
Hosseini Elham,
Janghorbani Mohsen
Publication year - 2018
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12644
Subject(s) - medicine , gestational diabetes , relative risk , pregnancy , obstetrics , observational study , incidence (geometry) , neonatal intensive care unit , diabetes mellitus , gestational hypertension , pediatrics , gestation , confidence interval , endocrinology , physics , genetics , optics , biology
Background There is an ongoing discussion about the optimal diagnostic strategy for gestational diabetes mellitus ( GDM ). Objective To assess the magnitude of the association between GDM diagnosed with the one‐step (International Association of Diabetes and Pregnancy Study Groups criteria) or two‐step (Carpenter and Coustan criteria) approach and selected adverse pregnancy outcomes. Search strategy Five electronic databases were searched up to October 2017 using Medical Subject Headings for each adverse outcome combined with the term “gestational diabetes.” Selection criteria Observational studies assessing the one‐step versus the two‐step diagnostic approach in GDM . Data collection and analysis Relative risks were extracted and random‐effects models were used to estimate pooled relative risks ( RR s). Main results A total of 41 663 participants from nine studies were included. Gestational diabetes mellitus was significantly associated with pre‐eclampsia ( RR 1.68 vs RR 1.77), cesarean delivery ( RR 1.28 vs RR 1.33), and large for gestational age ( RR 1.44 vs RR 1.68) when diagnosed with the one‐step versus the two‐step approach. A one‐step diagnosis also increased the risks of neonatal intensive care unit admission and gestational hypertension, whereas a two‐step diagnosis increased the incidence of macrosomia. Conclusions Women with GDM diagnosed with either the one‐step or the two‐step approach were at increased risk for selected adverse pregnancy outcomes. The associations with the two‐step method were slightly stronger.