Loading...
Please wait, while we are loading the content...
Similar Documents
Different strategies for diagnosing gestational diabetes to improve maternal and infant health
| Content Provider | Scilit |
|---|---|
| Author | Farrar, Diane Duley, Lelia Medley, Nancy Lawlor, Debbie A. |
| Copyright Year | 2015 |
| Abstract | Gestational diabetes mellitus (GDM) is carbohydrate intolerance resulting in hyperglycaemia with onset or first recognition during pregnancy. If untreated, perinatal morbidity and mortality may be increased. Accurate diagnosis allows appropriate treatment. Use of different tests and different criteria will influence which women are diagnosed with GDM. To evaluate and compare different testing strategies for diagnosis of gestational diabetes mellitus to improve maternal and infant health while assessing their impact on healthcare service costs. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014) and reference lists of retrieved studies. We included randomised trials if they evaluated tests carried out to diagnose GDM. We excluded studies that used a quasi-random model. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We identified six small trials, including 694 women. These trials were assessed as having varying risk of bias, with few outcomes reported. We prespecified six outcomes to be assessed for quality using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach; data for only one outcome (diagnosis of gestational diabetes) were available for assessment. One trial compared three different methods of delivering glucose: a candy bar (39 women), a 50-gram glucose polymer drink (40 women) and a 50-gram glucose monomer drink (43 women). We have reported results reported by this trial as separate comparisons. 75-gram oral glucose tolerance test (OGTT) versus 100-gram OGTT (one trial, 248 women): Women given the 75-gram OGTT had a higher relative risk of being diagnosed with GDM (risk ratio (RR) 2.55, 95% confidence interval (CI) 0.96 to 6.75). This difference was borderline in terms of statistical significance, and evidence was considered to be of very low quality when assessed by GRADE. No data were reported for the following additional outcomes prespecified for assessment in GRADE: caesarean section, macrosomia > 4.5 kg or however defined in the trial, long-term type 2 diabetes maternal, long-term type 2 diabetes infant and economic costs. Candy bar versus 50-gram glucose monomer drink (one trial, 60 women): More women receiving the candy bar, rather than glucose monomer, preferred the taste of the candy bar (RR 0.60, 95% CI 0.42 to 0.86). Infant outcomes were not reported. 50-gram glucose polymer drink versus 50-gram glucose monomer drink (three trials, 239 women): Mean difference (MD) in gestation at birth was -0.80 weeks (one trial, 100 women; 95% CI -1.69 to 0.09). Total side effects were less common with the glucose polymer drink (one trial, 63 women; RR 0.21, 95% CI 0.07 to 0.59), and no clear difference in taste acceptability was reported (one trial, 63 women; RR 0.99, 95% CI 0.76 to 1.29). Significantly fewer women reported nausea following the 50-gram glucose polymer drink compared... |
| Related Links | http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007122.pub3/pdf/abstract http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007122.pub3/pdf |
| DOI | 10.1002/14651858.cd007122.pub3 |
| Volume Number | 1 |
| Language | English |
| Publisher | Wiley-Blackwell |
| Publisher Date | 2015-01-21 |
| Access Restriction | Open |
| Subject Keyword | Obstetrics and Gynecology Gestational Diabetes |
| Content Type | Text |
