American journal of obstetrics & gynecology MFM

2589-9333652024MayAmerican journal of obstetrics & gynecology MFMAm J Obstet Gynecol MFMOne-step vs 2-step gestational diabetes mellitus screening and pregnancy outcomes: an updated systematic review and meta-analysis.10134610134610.1016/j.ajogmf.2024.101346S2589-9333(24)00072-7This was a systematic review and meta-analysis comparing maternal and neonatal outcomes of patients screened with the 1-step or 2-step screening method for gestational diabetes mellitus.PubMed, Scopus, Cochrane, ClinicalTrials.gov, and LILACS were searched from inception up to September 2022.Only randomized controlled trials were included. Studies that had overlapping populations were excluded (International Prospective Register of Systematic Review registration number: CRD42022358903).Risk ratios were computed with 95% confidence intervals by 2 authors. Unpublished data were requested. Large for gestational age was the primary outcome.The search yielded 394 citations. Moreover, 7 randomized controlled trials met the inclusion criteria. A total of 54,650 participants were screened for gestational diabetes mellitus by either the 1-step screening method (n=27,163) or the 2-step screening method (n=27,487). For large for gestational age, there was no significant difference found between the groups (risk ratio, 0.99; 95% confidence interval, 0.93-1.05; I²=0%). Newborns of patients who underwent 1-step screening had higher rates of neonatal hypoglycemia (risk ratio, 1.24; 95% confidence interval, 1.14-1.34; I²=0%) and neonatal intensive care unit admissions (risk ratio, 1.13; 95% confidence interval, 1.04-1.21; I²=0%) than newborns of patients who underwent 2-step screening. Patients in the 1-step screening method group were more likely to be diagnosed with gestational diabetes mellitus (risk ratio, 1.73; 95% confidence interval, 1.44-2.09; I²=80%) than patients in the 2-step screening method group. In addition, among trials that tested all patients before randomization and excluded patients with pregestational diabetes mellitus, newborns were more likely to have macrosomia (risk ratio, 1.27; 95% confidence interval, 1.21-1.34; I²=0%). Overall risk of bias assessment was of low concern.Large for gestational age did not differ between patients screened using the 1-step screening method and those screened using the 2-step screening method. However, patients randomized to the 1-step screening method had higher rates of neonatal hypoglycemia and neonatal intensive care unit admission and maternal gestational diabetes mellitus diagnosis than the patients randomized to the 2-step screening method.Copyright © 2024 Elsevier Inc. All rights reserved.GomesCintiaCDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Drs Gomes and Futterman, Mses Sher and Gluck, and Dr Fisher). Electronic address: cintiapavgomes@gmail.com.FuttermanItamar DIDDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Drs Gomes and Futterman, Mses Sher and Gluck, and Dr Fisher).SherOliviaODivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Drs Gomes and Futterman, Mses Sher and Gluck, and Dr Fisher).GluckBrachaBDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Drs Gomes and Futterman, Mses Sher and Gluck, and Dr Fisher).HillierTeresa ATAKaiser Permanente Center for Health Research, Portland, OR (Dr Hillier); Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI (Dr Hillier).Ramezani TehraniFahimehFReproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Ramezani Tehrani).ChaaraniNadimNDepartment of Medicine, University of Balamand, Balamand, El-Koura, Lebanon (Mr Chaarani).FisherNelliNDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Drs Gomes and Futterman, Mses Sher and Gluck, and Dr Fisher).BerghellaVincenzoVDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at the Thomas Jefferson University, Philadelphia, PA (Drs Berghella and McLaren).McLarenRodney ARAJrDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at the Thomas Jefferson University, Philadelphia, PA (Drs Berghella and McLaren).engSystematic ReviewJournal ArticleMeta-AnalysisReview20240311