Lower gestational diabetes thresholds increase diagnoses without improving short-term outcomes

This systematic review and meta-analysis included 17 studies; 10 studies, involving 81,528 women, contributed to pooled analyses. Compared with higher thresholds, lower diagnostic criteria doubled GDM diagnoses and pharmacotherapy use, but showed little to no effect on most short-term outcomes.

Lower thresholds doubled GDM diagnoses and pharmacotherapy use.
Neonatal hypoglycemia increased by 18 per 1,000 in trials.
Most short-term outcomes changed little or not at all.
Long-term and economic evidence remains limited.

Researchers compared maternal, neonatal, longer-term and economic outcomes after gestational diabetes (GDM) assessment using lower versus higher oral glucose tolerance test diagnostic criteria or thresholds. The review included 17 studies: nine randomized controlled trials and eight prospective cohort studies. Nine trials and one cohort study contributed to meta-analyses involving 81,528 women. The authors assessed risk of bias and evidence certainty using GRADE.

Lower criteria or thresholds doubled GDM diagnoses and pharmacotherapy use. In randomized trials, they were associated with 18 additional cases of neonatal hypoglycemia per 1,000 women (95% CI, 11 to 25 more) and six additional cases of maternal-neonatal separation per 1,000 (95% CI, 1 to 12 more). The review found little to no effect on other short-term outcomes.

Longer-term findings came from follow-up of one trial: lower thresholds were associated with reduced maternal hypertension and child neurodevelopmental impairment, but more subsequent GDM at five years. Economic findings were inconsistent, and no long-term economic data were available. The authors concluded that further high-quality trials with longer follow-up are needed; the findings do not establish an overall long-term benefit of lower thresholds.

In practice

For clinicians involved in antenatal care, this review suggests that using lower GDM diagnostic thresholds increases the number of patients diagnosed and treated, without improving most measured short-term outcomes; it was associated with more neonatal hypoglycemia and maternal-neonatal separation. These findings do not establish that higher thresholds are preferable: evidence on longer-term outcomes comes from one trial follow-up and included both possible benefits and increased subsequent GDM. The review does not establish a basis for changing diagnostic practice, and further long-term trial data are needed.

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Source

The Journal of Clinical Endocrinology & Metabolism: Short and long-term outcomes after gestational diabetes diagnosis using different glycemic criteria: a systematic review and meta-analysis ↗

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