One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial
ObjectivesThere is considerable worldwide controversy regarding optimal screening and diagnostic approaches for GDM. This study aimed to compare the prevalence, maternal and neonatal outcomes of a One-step with a Two-step approach for the screening and diagnosis of GDM in a large community sample of...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.1039643/full |
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| author | Fahimeh Ramezani Tehrani Maryam Rahmati Farshad Farzadfar Mehrandokht Abedini Maryam Farahmand Farhad Hosseinpanah Farzad Hadaegh Farahnaz Torkestani Majid Valizadeh Fereidoun Azizi Samira Behboudi-Gandevani |
| author_facet | Fahimeh Ramezani Tehrani Maryam Rahmati Farshad Farzadfar Mehrandokht Abedini Maryam Farahmand Farhad Hosseinpanah Farzad Hadaegh Farahnaz Torkestani Majid Valizadeh Fereidoun Azizi Samira Behboudi-Gandevani |
| author_sort | Fahimeh Ramezani Tehrani |
| collection | DOAJ |
| description | ObjectivesThere is considerable worldwide controversy regarding optimal screening and diagnostic approaches for GDM. This study aimed to compare the prevalence, maternal and neonatal outcomes of a One-step with a Two-step approach for the screening and diagnosis of GDM in a large community sample of pregnant women.MethodsWe conducted a secondary analysis of a randomized community non-inferiority trial of GDM screening in Iran. For the current study, all pregnant women who met the inclusion criteria were randomized into two groups for GDM screening. The first group of women (n = 14611) was screened by a One-step screening approach [75-g 2-h oral glucose tolerance test (OGTT)] and the second group (n = 14160) by a Two-step method (the 50-g glucose challenge test followed by the 100-g OGTT). All study participants were followed up until delivery, and the adverse maternal and neonatal outcomes were recorded in detail.ResultsGDM was diagnosed in 9.3% of the pregnant women who were assigned to the One-step and in 5.4% of those assigned to the Two-step approach with a statistically significant difference between them (p < 0.001). Intention-to-treat analyses showed no significant differences between the One-step and the Two-step group in the unadjusted risks of the adverse pregnancy outcomes of macrosomia, primary cesarean-section, preterm birth, hypoglycemia, hypocalcemia, hyperbilirubinemia, preeclampsia, neonatal intensive care unit admission, birth trauma, low birth weight, and intrauterine fetal death. Results remained unchanged after adjustment for potential confounder variables including gestational age at enrollment and delivery, maternal body mass index, gestational weight gain, type of delivery, treatment modality, and GDM diagnosis in the first trimester.ConclusionWe found that although the rates of GDM more than doubled with the One-step strategy, the One-step approach was similar to the Two-step approach in terms of maternal and neonatal outcomes. These findings may warn that more caution should be exercised in adopting the One-step method worldwide. Future research is needed to assess the long-term harm and benefits of those approaches to GDM screening for both mothers and their offspring.Clinical trial registrationhttps://www.irct.ir/trial/518, identifier (IRCT138707081281N1). |
| first_indexed | 2024-04-10T18:15:09Z |
| format | Article |
| id | doaj.art-c87f4b976ad04a239789b3b0bcbb1a85 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-10T18:15:09Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-c87f4b976ad04a239789b3b0bcbb1a852023-02-02T09:06:01ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-02-011310.3389/fendo.2022.10396431039643One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trialFahimeh Ramezani Tehrani0Maryam Rahmati1Farshad Farzadfar2Mehrandokht Abedini3Maryam Farahmand4Farhad Hosseinpanah5Farzad Hadaegh6Farahnaz Torkestani7Majid Valizadeh8Fereidoun Azizi9Samira Behboudi-Gandevani10Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranReproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IranInfertility and Cell Therapy Office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran, IranReproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranObesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranPrevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranFaculty of Medicine, Shahed University, Tehran, IranObesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranEndocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranFaculty of Nursing and Health Sciences, Nord University, Bodø, NorwayObjectivesThere is considerable worldwide controversy regarding optimal screening and diagnostic approaches for GDM. This study aimed to compare the prevalence, maternal and neonatal outcomes of a One-step with a Two-step approach for the screening and diagnosis of GDM in a large community sample of pregnant women.MethodsWe conducted a secondary analysis of a randomized community non-inferiority trial of GDM screening in Iran. For the current study, all pregnant women who met the inclusion criteria were randomized into two groups for GDM screening. The first group of women (n = 14611) was screened by a One-step screening approach [75-g 2-h oral glucose tolerance test (OGTT)] and the second group (n = 14160) by a Two-step method (the 50-g glucose challenge test followed by the 100-g OGTT). All study participants were followed up until delivery, and the adverse maternal and neonatal outcomes were recorded in detail.ResultsGDM was diagnosed in 9.3% of the pregnant women who were assigned to the One-step and in 5.4% of those assigned to the Two-step approach with a statistically significant difference between them (p < 0.001). Intention-to-treat analyses showed no significant differences between the One-step and the Two-step group in the unadjusted risks of the adverse pregnancy outcomes of macrosomia, primary cesarean-section, preterm birth, hypoglycemia, hypocalcemia, hyperbilirubinemia, preeclampsia, neonatal intensive care unit admission, birth trauma, low birth weight, and intrauterine fetal death. Results remained unchanged after adjustment for potential confounder variables including gestational age at enrollment and delivery, maternal body mass index, gestational weight gain, type of delivery, treatment modality, and GDM diagnosis in the first trimester.ConclusionWe found that although the rates of GDM more than doubled with the One-step strategy, the One-step approach was similar to the Two-step approach in terms of maternal and neonatal outcomes. These findings may warn that more caution should be exercised in adopting the One-step method worldwide. Future research is needed to assess the long-term harm and benefits of those approaches to GDM screening for both mothers and their offspring.Clinical trial registrationhttps://www.irct.ir/trial/518, identifier (IRCT138707081281N1).https://www.frontiersin.org/articles/10.3389/fendo.2022.1039643/fullgestational diabetesmaternal and neonatal outcomesone-step screening approachprevalencetwo-step screening approach |
| spellingShingle | Fahimeh Ramezani Tehrani Maryam Rahmati Farshad Farzadfar Mehrandokht Abedini Maryam Farahmand Farhad Hosseinpanah Farzad Hadaegh Farahnaz Torkestani Majid Valizadeh Fereidoun Azizi Samira Behboudi-Gandevani One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial Frontiers in Endocrinology gestational diabetes maternal and neonatal outcomes one-step screening approach prevalence two-step screening approach |
| title | One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial |
| title_full | One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial |
| title_fullStr | One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial |
| title_full_unstemmed | One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial |
| title_short | One-step versus two-step screening for diagnosis of gestational diabetes mellitus in Iranian population: A randomized community trial |
| title_sort | one step versus two step screening for diagnosis of gestational diabetes mellitus in iranian population a randomized community trial |
| topic | gestational diabetes maternal and neonatal outcomes one-step screening approach prevalence two-step screening approach |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.1039643/full |
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