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Incidence, risk factors, and pregnancy outcomes of gestational diabetes mellitus using one-step versus two-step diagnostic approaches: A population-based cohort study in Isfahan, Iran.
Diabetes Res Clin Pract 2018; 140:288-294DR

Abstract

AIMS

To study the incidence, risk factors, and pregnancy outcomes associated with gestational diabetes mellitus (GDM) diagnosed with one-step and two-step screening approaches.

METHODS

1000 pregnant women who were eligible and consented to participate underwent fasting plasma glucose testing at the first prenatal visit (6-14 weeks). The women free from GDM or overt diabetes were screened at 24-28 weeks using the 50-g glucose challenge test (GCT) followed by 100-g, 3-h oral glucose tolerance test (OGTT) (two-step method). Regardless of the GCT result, all women underwent a 75-g, 2-h OGTT within one-week interval (one-step method).

RESULTS

GDM incidence using the one-step and two-step methods was 9.3% (95% CI: 7.4-11.2) and 4.2% (95% CI: 2.9-5.5). GDM significantly increased the risk of macrosomia, gestational hypertension, preeclampsia, and cesarean section and older age and family history of diabetes significantly increased the risk of developing GDM in both approaches. In two-step method, higher pre-pregnancy body mass index and lower physical activity during pregnancy along with higher earlier cesarean section also increased significantly the risk of developing GDM.

CONCLUSIONS

Despite a higher incidence of GDM using the one-step approach, more risk factors for and a stronger effect of GDM on adverse pregnancy outcomes were found when using the two-step approach. Longer follow-up of women with and without GDM may change the results using both approaches.

Authors+Show Affiliations

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: janghorbani@hlth.mui.ac.ir.Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29649540

Citation

Hosseini, Elham, et al. "Incidence, Risk Factors, and Pregnancy Outcomes of Gestational Diabetes Mellitus Using One-step Versus Two-step Diagnostic Approaches: a Population-based Cohort Study in Isfahan, Iran." Diabetes Research and Clinical Practice, vol. 140, 2018, pp. 288-294.
Hosseini E, Janghorbani M, Aminorroaya A. Incidence, risk factors, and pregnancy outcomes of gestational diabetes mellitus using one-step versus two-step diagnostic approaches: A population-based cohort study in Isfahan, Iran. Diabetes Res Clin Pract. 2018;140:288-294.
Hosseini, E., Janghorbani, M., & Aminorroaya, A. (2018). Incidence, risk factors, and pregnancy outcomes of gestational diabetes mellitus using one-step versus two-step diagnostic approaches: A population-based cohort study in Isfahan, Iran. Diabetes Research and Clinical Practice, 140, pp. 288-294. doi:10.1016/j.diabres.2018.04.014.
Hosseini E, Janghorbani M, Aminorroaya A. Incidence, Risk Factors, and Pregnancy Outcomes of Gestational Diabetes Mellitus Using One-step Versus Two-step Diagnostic Approaches: a Population-based Cohort Study in Isfahan, Iran. Diabetes Res Clin Pract. 2018;140:288-294. PubMed PMID: 29649540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence, risk factors, and pregnancy outcomes of gestational diabetes mellitus using one-step versus two-step diagnostic approaches: A population-based cohort study in Isfahan, Iran. AU - Hosseini,Elham, AU - Janghorbani,Mohsen, AU - Aminorroaya,Ashraf, Y1 - 2018/04/10/ PY - 2017/08/06/received PY - 2018/03/12/revised PY - 2018/04/04/accepted PY - 2018/4/13/pubmed PY - 2018/7/26/medline PY - 2018/4/13/entrez KW - Gestational diabetes KW - Incidence KW - Iran KW - Pregnancy outcomes KW - Risk factor KW - Screening SP - 288 EP - 294 JF - Diabetes research and clinical practice JO - Diabetes Res. Clin. Pract. VL - 140 N2 - AIMS: To study the incidence, risk factors, and pregnancy outcomes associated with gestational diabetes mellitus (GDM) diagnosed with one-step and two-step screening approaches. METHODS: 1000 pregnant women who were eligible and consented to participate underwent fasting plasma glucose testing at the first prenatal visit (6-14 weeks). The women free from GDM or overt diabetes were screened at 24-28 weeks using the 50-g glucose challenge test (GCT) followed by 100-g, 3-h oral glucose tolerance test (OGTT) (two-step method). Regardless of the GCT result, all women underwent a 75-g, 2-h OGTT within one-week interval (one-step method). RESULTS: GDM incidence using the one-step and two-step methods was 9.3% (95% CI: 7.4-11.2) and 4.2% (95% CI: 2.9-5.5). GDM significantly increased the risk of macrosomia, gestational hypertension, preeclampsia, and cesarean section and older age and family history of diabetes significantly increased the risk of developing GDM in both approaches. In two-step method, higher pre-pregnancy body mass index and lower physical activity during pregnancy along with higher earlier cesarean section also increased significantly the risk of developing GDM. CONCLUSIONS: Despite a higher incidence of GDM using the one-step approach, more risk factors for and a stronger effect of GDM on adverse pregnancy outcomes were found when using the two-step approach. Longer follow-up of women with and without GDM may change the results using both approaches. SN - 1872-8227 UR - https://www.unboundmedicine.com/medline/citation/29649540/Incidence_risk_factors_and_pregnancy_outcomes_of_gestational_diabetes_mellitus_using_one_step_versus_two_step_diagnostic_approaches:_A_population_based_cohort_study_in_Isfahan_Iran_ DB - PRIME DP - Unbound Medicine ER -