COMPARATIVE ANALYSIS OF ONE-STEP VERSUS TWO-STEP SCREENING STRATEGIES FOR GESTATIONAL DIABETES MELLITUS ON PERINATAL OUTCOMES IN A TERTIARY CARE SETTING

Dr. Maria Gonzalez; MD; Dr. Carlos Rivera; MD

Abstract

This study addresses the critical clinical debate surrounding the efficacy of differing screening methodologies for Gestational Diabetes Mellitus (GDM) and their subsequent impact on maternal and fetal health. Utilizing a retrospective cohort design, we compared the 'One-Step' 75g Oral Glucose Tolerance Test (OGTT) recommended by the IADPSG with the traditional 'Two-Step' approach (50g GCT followed by 100g OGTT). The research evaluates how shift in diagnostic thresholds influences GDM prevalence rates and whether the heightened sensitivity of the One-Step approach correlates with a significant reduction in adverse perinatal complications. Data from 942 pregnant participants were analyzed to determine the incidence of macrosomia, cesarean delivery, and neonatal hypoglycemia. Our findings provide evidence-based insights into the trade-offs between increased diagnostic labeling and improved clinical outcomes, contributing to the optimization of prenatal care protocols in high-risk populations. The results underscore the necessity for standardized global screening to mitigate the long-term metabolic risks associated with undiagnosed hyperglycemic states in pregnancy.

Keywords: Gestational Diabetes Mellitus, Perinatal Outcomes, OGTT Screening, IADPSG Criteria, Macrosomia, Neonatal Hypoglycemia, Maternal Health, Obstetric Medicine

Gestational Diabetes Mellitus (GDM) remains one of the most prevalent complications of pregnancy, affecting up to 15% of pregnancies globally. Despite its prevalence, there is no universal consensus on the optimal screening strategy, leading to significant variations in clinical practice. The relevance of this study lies in its direct comparison of two widely adopted yet divergent diagnostic frameworks in a real-world clinical setting. As maternal obesity and maternal age at conception continue to rise, the selection of a screening tool that balances sensitivity with resource allocation is vital. By quantifying the reduction in perinatal risks associated with more intensive screening, this research assists healthcare providers and policymakers in refining obstetric guidelines. Effective GDM management, initiated by accurate screening, is a cornerstone of preventing the intergenerational cycle of obesity and Type 2 Diabetes, making this study highly pertinent to modern reproductive medicine and public health.

To evaluate the comparative effectiveness of 'One-Step' versus 'Two-Step' GDM screening strategies in reducing adverse perinatal outcomes and to analyze the diagnostic yield of each method within a diverse obstetric population.

A retrospective comparative cohort study was conducted at a tertiary maternity center involving 942 pregnant women between January 2021 and June 2023. Participants were divided into two groups based on the screening protocol utilized: Group A (n=458) underwent the 'One-Step' 75g OGTT (IADPSG criteria), and Group B (n=484) followed the 'Two-Step' 50g/100g procedure (Carpenter-Coustan criteria). Primary outcomes measured included maternal weight gain, mode of delivery, and birth weight. Secondary outcomes focused on neonatal complications, including 5-minute Apgar scores

4000g), occurring in 6.4% of births versus 12.1% in Group B (aOR 0.51; 95% CI 0.28–0.93). The primary cesarean delivery rate was also lower in the One-Step group (19.4% vs. 26.2%, p=0.015). Neonatal hypoglycemia was recorded in 4.7% of Group A cases compared to 9.3% in Group B (p=0.008). Multivariable regression indicated that women diagnosed via the One-Step approach had lower odds of experiencing preeclampsia (aOR 0.44; 95% CI 0.21–0.91). No significant difference was observed in NICU admission rates between the two groups (p=0.12). These results suggest that identifying milder cases of hyperglycemia through the One-Step method allows for interventions that effectively reduce heavy-birthweight-related complications.

The transition to the 'One-Step' IADPSG screening criteria significantly increases GDM diagnosis rates but offers a clear clinical advantage in reducing the incidence of macrosomia and emergency cesarean sections. The identification of 'mild' GDM cases—previously missed by the two-step method—allows for early nutritional and pharmacological intervention, which is instrumental in improving neonatal metabolic health. However, the increased burden on healthcare resources due to higher patient volumes must be balanced against these improved outcomes. We recommend the adoption of the 'One-Step' strategy particularly in populations with high metabolic risk factors to ensure maximal prevention of perinatal morbidity. Further prospective studies are warranted to evaluate the long-term cost-effectiveness of this approach.