Jul 2, 2013

US Task Force Urges Gestational Diabetes Testing at 24 Weeks

The US Preventive Services Task Force issued a draft statement earlier this week that recommends screening asymptomatic pregnant women at 24 weeks for gestational diabetes, based on what it says is solid evidence. It also calls for the public to visit its Web site and comment on this draft during the next month.

“In 2008, [the most recent task-force recommendation] for gestational diabetes screening after 24 weeks was an ‘I statement,’ meaning there was insufficient evidence to support screening,” task-force member Wanda K. Nicholson, MD, from the University of North Carolina at Chapel Hill, told Medscape Medical News. “Now we’ve moved to a ‘B recommendation’ due to the publication of 2 large clinical trials that show that the benefits of screening for both mom and baby — both patients — outweigh any harm.”

The task force found adequate evidence that screening for gestational diabetes at 24 weeks and treating it with dietary modifications, glucose monitoring, and insulin if needed can significantly reduce the risk of preeclampsia for the mother and the risk of macrosomia and shoulder dystocia for the baby.

These benefits outweighed potential risks, including psychological harms, aggressive medical interventions such as induction of labor and cesarean delivery, or maternal hypoglycemia.

However, as in 2008, there is insufficient evidence to support screening earlier in the pregnancy, so that remains an “I statement.”

The task force is an independent volunteer panel of experts in prevention and evidence-based medicine. To update their 2008 recommendations, they examined a review of 51 screening studies and another review of 22 studies of benefits vs harms of treating gestational diabetes, which are published online May 28 in Annals of Internal Medicine.

The most commonly used test to detect gestational diabetes in the US is the 50-g oral glucose challenge test, although there is no gold-standard, universally accepted screening method. “Our goal was not to look at the performance or whether one test was better than another for screening,” Dr. Donovan said. “We looked at…whether the benefits outweigh any harm.”

Approximately 7% of the 4 million women who give birth each year in the United States develop gestational diabetes, according to the task-force report. The condition is increasing as risk factors such as obesity and older age at pregnancy become more common. Other risk factors include having a family history of diabetes or belonging to an ethnic group at increased risk of developing type 2 diabetes (such as Hispanic, Native American, South or East Asian, African American, or Pacific Islands descent).

“Asymptomatic” women are those who have not been diagnosed with type 1 or type 2 diabetes, Dr. Nicholson said. It is especially important for women who are at high risk “to have a conversation with their clinician about having a healthy diet and what they can do during the early stage of their pregnancy to hopefully prevent screening positive for gestational diabetes,” she stressed.

The task force’s draft recommendation statement is posted at www.uspreventiveservicestaskforce.org. Dr. Nicholson encourages physicians, women who have had gestational diabetes in the past, public-health officials, and others to submit comments from May 28 to June 24 here. These will be reviewed and incorporated into the final statement of recommendations, which is expected to be published within the next 4 months.

The 2 reviews were funded by the Agency for Healthcare Research and Quality. Dr. Donovan also reports receiving grant money from the International Diabetes Federation and Eli Lilly.

Ann Intern Med . Published online May 28, 2013. Screening review Benefits and harms review

— Marlene Busko


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