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USPSTF: Insufficient evidence on screening for gestational diabetes before 24 weeks
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The current evidence on the balance of the risks and benefits of screening for gestational diabetes in asymptomatic pregnant women before 24 weeks is limited, according to a new US Preventive Services Task Force recommendation statement.
On behalf of the US Preventive Services Task Force (USPSTF), Virginia A. Moyer, MD, MPH, of Baylor College of Medicine, wrote that pregnant women with gestational diabetes are at an increased risk for maternal and fetal complications, including preeclampsia, fetal macrosomia and neonatal hypoglycemia. Women with gestational diabetes also have an increased risk for developing type 2 diabetes.
Traditionally, screening for gestational diabetes occurs after 24 weeks gestation. The most commonly used test in the United States is a two-step approach using the 50-g oral glucose challenge test between 24 and 28 weeks of gestation. If the screening threshold is met or exceeded (130 mg/dL, 135 mg/dL, or 140 mg/dL), patients receive the oral glucose tolerance test, according to the document.
Virginia A. Moyer
Overall, the USPSTF found that the evidence available is insufficient to assess the balance of benefits and harms of screening for gestational diabetes in women before 24 weeks of gestation.
“Potential harms of screening for gestational diabetes include psychological harms and intensive medical interventions (induction of labor, cesarean delivery, or admission to the neonatal intensive care unit). Possible adverse effects of treatment include neonatal or maternal hypoglycemia and maternal stress,” Moyer wrote.
Steps can be taken to prevent gestational diabetes, but more research is needed to evaluate the screening of gestational diabetes, she said.
“If a pregnant woman presents in the first trimester or in early pregnancy with risk factors for type 2 diabetes, clinicians should use their clinical judgment to determine what is appropriate screening for that individual patient, given her health needs and the insufficient evidence,” Moyer wrote.
Disclosure: Moyer reports support for travel to meetings for the study or other purposes.
Perspective
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Ian Blumer, MD
The USPSTF determination that there is justification for screening for gestational diabetes is in alignment with the Endocrine Society’s Diabetes and Pregnancy guideline and with the recommendations of many other organizations.
The Endocrine Society guideline, however, goes above and beyond the USPSTF observations in that our guideline provides direction to health care providers on how to conduct the screening (ie, what should be done, how it should be done, and what are the diagnostic cutoffs) as well as providing direction regarding the management of gestational diabetes including nutrition therapy, exercise, target blood glucose values, and the use of antihyperglycemic medications.
All of us in the diabetes field are aware of the controversies regarding gestational diabetes and it is nice indeed to see that the USPSTF has come out recognizing the justification for screening for this condition. Health care providers will benefit from the increasing alignment in this messaging coming from myriad organizations.
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