- Therapeutic Management, Delivery, and Postpartum Risk Assessment and Screening in Gestational Diabetes [Entered Retrospectively]
- Objectives: We focused on four questions: (1) What are the risks and benefits of an oral diabetes agent (i.e., glyburide), as compared to all types of insulin, for gestational diabetes? (2) What is the evidence that elective labor induction, cesarean delivery, or timing of induction is associated with benefits or harm to the mother and neonate? (3) What risk factors are associated with the development of type 2 diabetes after gestational diabetes? (4) What are the performance characteristics of diagnostic tests for type 2 diabetes in women with gestational diabetes? Data Sources: We searched electronic databases for studies published through January 2007. Additional articles were identified by searching the table of contents of 13 journals for relevant citations from August 2006 to January 2007 and reviewing the references in eligible articles and selected review articles. Review Methods: Paired investigators reviewed abstracts and full articles. We included studies that were written in English, reported on human subjects, contained original data, and evaluated women with appropriately diagnosed gestational diabetes. Paired reviewers performed serial abstraction of data from each eligible study. Study quality was assessed independently by each reviewer. Main Results: The search identified 45 relevant articles. The evidence indicated that (1) maternal glucose levels do not differ substantially in those treated with insulin versus insulin analogues or oral agents; (2) average infant birth weight may be lower in mothers treated with insulin than with glyburide; (3) induction at 38 weeks may reduce the macrosomia rate, with no increase in cesarean delivery rates; (4) anthropometric measures, fasting blood glucose (FBG), and 2-hour glucose value are the strongest risk factors associated with development of type 2 diabetes; (5) FBG had high specificity, but variable sensitivity, when compared to the 75-gm oral glucose tolerance test (OGTT) in the diagnosis of type 2 diabetes after delivery. Conclusions: The evidence suggests that benefits and a low likelihood of harm are associated with the treatment of gestational diabetes with an oral diabetes agent or insulin. The effect of induction or elective cesarean on outcomes is unclear. The evidence is consistent that anthropometry identifies women at risk of developing subsequent type 2 diabetes; however, no evidence suggested the FBG out-performs the 75-gm OGTT in diagnosing type 2 diabetes after delivery.
- Authors of Report
- Methodology description
- We identified the primary literature on labor and postpartum management of gestational diabetes and the association with maternal and neonatal outcomes through a comprehensive search plan that included electronic and hand searching. We ran searches of the following databases for the specified periods of time: MEDLINE® (1950 through January 2007), EMBASE® (1974 through January 2007), The Cochrane Central Register of Controlled Trials (CENTRAL; Issue 1, 2007), and the Cumulative Index to Nursing & Allied Health Literature (CINAHL®; 1982 through January 2007). Hand searching for relevant citations took several forms. From our electronic search, we identified the 13 journals (see Appendix Ba) that were most likely to publish articles on this topic. We scanned the table of contents of each issue of these journals for relevant articles from August 2006 through January 2007. For the second form of hand searching, reviewers received eligible articles and flagged references of interest for the team to compare to the existing database.
Two independent reviewers conducted title scans in a parallel fashion. If either reviewer thought that a title was potentially eligible, its abstract was reviewed. If the abstract was deemed to meet the inclusion criteria by two reviewers, the abstract was included in our article review. Any differences of opinion were resolved by the two primary reviewers or by a third independent reviewer.
Each eligible article underwent double review by study investigators. A primary reviewer completed all data abstraction forms, and a second reviewer confirmed the first reviewer’s data abstraction forms for completeness and accuracy. The reviewers assessed study quality independently. Reviewer pairs were formed to include personnel with both clinical and methodological expertise. A third reviewer re-reviewed a random sample of articles by the first two reviewers to ensure consistency in the abstraction of the articles.
- The systematic review data of this published project was retrospectively imported into SRDR by the Brown EPC on behalf of the Johns Hopkins EPC and the Agency for Healthcare Research and Quality (AHRQ).
For access to the full report available on the AHRQ website, follow this link: http://www.ahrq.gov/research/findings/evidence-based-reports/gestdiabtp.html
- Funding Source
- The Agency for Healthcare Research and Quality (AHRQ)