Publication:

A comparative study on one-step versus two-step screening methods for gestational diabetes mellitus and their impact on maternal and fetal outcome

Background Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and fetal outcomes. The one-step IADPSG and two-step ACOG screening methods are widely used for diagnosis. The one-step approach detects more cases of GDM, potentially enabling earlier treatment, but concerns regarding overdiagnosis and increased healthcare costs remain. Aim and objectives were to compare the one-step and two-step screening methods for gestational diabetes mellitus (GDM) in terms of prevalence, maternal and fetal outcomes, and to determine which method correlates better with adverse fetomaternal outcomes.

Methods This prospective comparative study was conducted at Midnapore Medical College and Hospital from January to December 2024 and included 1,720 pregnant women with gestational age ≤24 weeks. Participants were randomly assigned to either group A (one-step IADPSG screening, n=860) or group B (two-step ACOG screening, n=860) for GDM screening. Women diagnosed with GDM were managed according to standard protocols and followed until delivery. Maternal and fetal outcomes were assessed and compared between the two groups using statistical analysis.

Results Among 860 pregnant women screened by each method, GDM was diagnosed in 92 (10.69%) women using the one-step method and 66 (7.67%) women using the two-step method. During follow-up, 88 and 62 women remained in groups A and B, respectively. Maternal complications such as preeclampsia and polyhydramnios were comparable between the groups (p=0.964). The caesarean section rate was significantly higher in the one-step group than in the two-step group (68.18% versus 41.93%; p=0.024). Mean APGAR scores were similar in both groups (8.41±0.92 versus 8.71±0.82; p=0.151). Fetal outcomes, including preterm birth, low birth weight, neonatal hypoglycemia, large-for-gestational-age, hyperbilirubinemia, and NICU admission, were comparable between the groups (p=0.938).

Conclusions One-step method detected more GDM cases than the two-step method, but maternal and fetal outcomes were similar. The one-step approach is simpler, more economical, and has better patient compliance.