U PREVENTIVE SERVICES TASK FORCE ...

U PREVENTIVE SERVICES TASK FORCE

This statement summarizes the existing U.S. Preventive Services Task Force (USPSTF) recommendation forward screening for gestational diabetes and the supporting scientific evidence. It updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, next to the first edition. (1) Explanations of the ratings and of the might of overall evidence are given in Tables 1 and 2 respectively. The integral information on which this statement is based, including evidence tables and respects is available in the summary of the evidence, "Screening for Gestational Diabetes: A Summary of the Evidence for the U Preventive Services Task Force" (2) and in the Systematic Evidence Review (3) onward this topic, which can be obtained [i]or[/i] part of to the other the USPSTF Web site (www.preventiveservices.ahrq.gov). The summary of the evidence and the recommendation statement are also available in print end the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone: 800-358-9295; e-mail: ahrqpubs@ahrq.gov).

Summary of Recommendation

* The USPSTF infers that the evidence is insufficient to make acceptable for or against routine screening for gestational diabetes.

I recommendation.

The USPSTF plant fair to good evidence that screening combined with diet and insulin therapy can model the rate of fetal macrosomia in women with gestational diabetes mellitus (GDM) The USPSTF originate insufficient evidence, however, that screening for GDM substantially diminishs important adverse health outcomes for mothers or their infants (eg cesarean delivery, birth injury, neonatal morbidity or mortality). Screening shows frequent false-positive results, and the diagnosis of GDM may be associated with other harms, similar as negatively affecting a woman's perception of her health, on the other hand data are limited. Therefore, the USPSTF could not determine the balance of benefits and harms of screening for GDM

Clinical Considerations

* Better quality evidence is indigenceed to determine whether the benefits of screening for GDM outweigh the harms. Until of the like kind evidence is available, clinicians might reasonably select not to screen at all or to guard only women at increased risk for GDM

* Patient characteristics principally strongly associated with increased risk for GDM include maternal obesity (usually defined as a material part mass index [BMI] of 25 kg by [m.sup.2] or more), older age (usually defined as older than 25 years), family or personal history of diabetes, or a history of GDM in a prior pregnancy. apt groups also have identified certain ethnic collections as being at increased risk for GDM (eg Hispanic, African American, American Indian, and southern or East Asian). Using all the above criteria, however, would identify 90 percent of all pregnant women as being at increased risk for GDM

* The optimal approach to screening and diagnosis is uncertain. [i]connoisseur[/i] panels in the United States commit a 50-g one-hour glucose challenge experiment (GCT) at 24 to 28 weeks' gestation, followed on a 100-g three-hour oral grape-sugar tolerance test (OGTT) for women who protection positive on the GCT. Different screening and diagnostic strategies attract favor toed by the World Health Organization (WHO) are commonly used outside of North America. The American Diabetes Association (ADA) and the WHO have published specific criteria for diagnosis, unless the USPSTF could not determine the relative benefits of any specific approach. (45)

Scientific Evidence

EPIDEMIOLOGY AND CLINICAL CONSEQUENCES

GDM is defined as grape-sugar intolerance with onset or first detection during pregnancy. (67) GDM present itselfs in 2 to 5 percent of all pregnancies, or approximately 135000 cases annually in the United States. (6) Major risk factors for developing GDM include increased maternal age, family history of diabetes, history of GDM in a prior pregnancy, and increased pregravid BMI. (8) The prevalence of GDM varies in direct proportion to the prevalence of impressed sign 2 diabetes in a given population or ethnic collection (6) GDM is more habitual among African-American, Hispanic, and American-Indian women and les usual among Asian women. Variations in screening practices and in other risk factors make it difficult to quantify the independent contribution of race and ethnicity to developing GDM Prevalence of GDM in women with defined low-risk factors, similar as being of white ethnic origin, being younger than 25 years, and having a BMI of les than 25 kg by [m.sup.2], ranges from 1.4 to 28 percent (9-14) The prevalence of GDM in women with defined high-risk factors, of the like kind as being older than 25 years, being obese, or having a family history of diabetes, ranges from 33 to 61 percent (11)

GDM has been linked to increased maternal perinatal morbidity (resulting from an increase in cesarean deliveries and forceps or vacuum extraction, as well as third- and fourth-degree lacerations), principally by means of its association with fetal macrosomia. (15-22)

Macrosomia is associated with an increased risk for neonatal adverse results such as brachial plexus injuries (most of which are temporary) and clavicular fracture. (172123-24) Data onward the overall impact of GDM screening and treatment forward these outcomes is limited because in the greatest degree babies with macrosomia are born to mothers without GDM (1525-29) and principally cases of injuries related to shoulder dystocia befall in pregnancies with infants of normal birth weight. The relationship between GDM and adverse issues is further confounded by the fact that maternal obesity is an independent risk factor for many of the same issues (16,30,31) The tendency of clinicians to differently manage women who bear the diagnosis of GDM from those who do not may contribute to the observ increase in risk for cesarean delivery in women with GDM (4)