Authors' objectives:

To systematically review the evidence about the benefits and harms of screening pregnant women for gestational diabetes mellitus (GDM).

Authors' results and conclusions: No well-conducted RCT provides direct evidence for the health benefits of screening for GDM. The impact of hyperglycemia on adverse maternal and fetal health outcomes is probably continuous; the magnitude of any increased risk for the large number of women at lower levels of hyperglycemia is uncertain. The evidence is unclear about the optimal screening and reference diagnostic test and cutpoint for GDM. Although insulin therapy decreases the incidence of fetal macrosomia for those women with higher levels of hyperglycemia, the magnitude of any effect on maternal and neonatal health outcomes is not clear. The evidence is insufficient to determine the magnitude of health benefit for any treatment among the large number of women with GDM at lower levels of hyperglycemia. No properly controlled prospective trials show that antepartum surveillance in patients with GDM is beneficial when compared to those with GDM but who are not monitored. As the magnitude of benefit of screening and treating GDM is uncertain, so to is the cost-effectiveness of this strategy. We found limited evidence about the potential adverse effects of screening for GDM.

Authors' recommendations: The evidence of screening for GDM is insufficient to determine the extent to which screening has an important impact on maternal and neonatal health outcomes. The balance of benefits versus harms remains in question, especially for the large number of women with lower degrees of hyperglycemia. There is no evidence from prospective trials that screening for GDM is a cost-effective strategy. An RCT of screening is necessary to answer the many remaining questions.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/uspstf/uspsgdm.htm

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)