Effects of a Province-Wide Change in Gestational Diabetes Mellitus Screening Policy on Treatment and Newborn Birth Weight.

Abstract

To evaluate changes in gestational diabetes mellitus (GDM) treatment and newborn birth weight after a 2010 change in GDM screening recommendations from a two-step (50-g glucose challenge test + 3-h, 100-g oral glucose tolerance test [OGTT] with Carpenter-Coustan criteria) to a mix of one-step and two-step (2-h, 75-g OGTT with International Association for Diabetes in Pregnancy Study Group criteria). We estimated effects of the screening change on the incidence of lifestyle or medication treatment, infant birth weight >90th percentile or <10th percentile for gestational age (large and small for gestational age), and endocrinologist visits using interrupted time series analysis in all 463,881 individuals with singleton pregnancies (>28 gestational weeks) from British Columbia, Canada, between 2004 and 2019. After the screening change, lifestyle-treated GDM increased immediately (level change 1.85 [95% CI 1.19-2.51]), corresponding to a 1.85% increase in incidence. Medication-treated GDM increased gradually (trend change 0.23 [95% CI 0.09-0.37] per year), but there was no change in medication-treated GDM using a shorter (3-year) postpolicy period (level change -0.31 [95% CI -0.9 to 0.29]; trend change 0.03 [95% CI -0.36 to 0.43]). We detected no change in infant birth weight outcomes and endocrinology visits. Changing the screening approach substantially increased diagnoses of lifestyle-treated GDM but did not impact medication-treated GDM or infant birth weight.