{ "release_id": "c7fb95f1d15a7d13", "id": "maternal:gdm-glucose-screening-test", "owner": "maternal", "kind": "intervention", "slug": "gdm-glucose-screening-test", "name": "Glucose tests for gestational diabetes (one-step and two-step)", "aliases": [], "atlases": [ "maternal" ], "summary_plain": "Pregnant people are usually tested for gestational diabetes between 24 and 28 weeks. The test uses a sugary drink and blood samples. In the one-step approach, a 75 g drink is given after fasting and blood sugar is measured. In the two-step approach, a 50 g drink is given without fasting and, if the result is high, a second test with a 100 g drink follows. In a US trial of 23,792 women, one-step screening diagnosed gestational diabetes in 16.5% and two-step screening in 8.5%, and the main pregnancy outcomes did not differ significantly between the two.", "summary_technical": "Sources: the USPSTF 2021 statement (for asymptomatic pregnant persons not previously diagnosed with type 1 or type 2 diabetes: screening at 24 weeks or after, a B recommendation; before 24 weeks, an I statement), which does not choose a test; the ScreenR2GDM pragmatic trial (NEJM 2021); and the IADPSG consensus report of 2010. The trial compares whole pathways, since treatment guidelines matched each approach.", "editorial_state": "draft", "last_substantive_edit": "2026-10-14", "last_evidence_check": "2026-10-14", "next_review_due": null, "identifiers": [], "navigation": { "maternal": { "life-stage": [ "pregnancy" ], "care-area": [ "pregnancy-conditions" ] } }, "payload": { "subtype": "test", "mechanism": null, "components": null }, "content_digest": "489ef07e1e73e518d44d688c622f54078a7d507b9d2ae62a5ebf2f0785180eb3", "review": { "content_digest": "489ef07e1e73e518d44d688c622f54078a7d507b9d2ae62a5ebf2f0785180eb3", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "c7fb95f1d15a7d13", "id": "maternal:claim-iadpsg-75g-ogtt-24-28-weeks", "owner": "maternal", "subject_entity_id": "maternal:gdm-glucose-screening-test", "category": "recommendation", "statement": "The International Association of Diabetes and Pregnancy Study Groups (IADPSG) consensus panel recommends a two-hour 75-g oral glucose tolerance test, performed after an overnight fast, for all women not previously found to have overt diabetes or gestational diabetes during testing earlier in the pregnancy. It places the test at 24 to 28 weeks of gestation and says one or more values from the 75-g test being equaled or exceeded is enough for a diagnosis of gestational diabetes, using thresholds in its Table 1. It does not recommend routinely performing oral glucose tolerance tests before 24 to 28 weeks, and it says it considered the HAPO study results in depth in setting the diagnostic thresholds.", "context": { "id": "maternal:ctx-iadpsg-women-not-known-to-have-diabetes", "label": "Women not previously found to have overt diabetes or gestational diabetes (IADPSG)", "recipient": "maternal", "population": "Pregnant women not previously found to have overt diabetes or gestational diabetes during testing earlier in the same pregnancy. The panel applies the strategy to women without known diabetes before pregnancy.", "care_setting": "Not stated in the PubMed abstract", "geography": "International (consensus panel of the International Association of Diabetes and Pregnancy Study Groups).", "life_stage_note": "Pregnancy, testing at 24 to 28 weeks of gestation", "life_stage_terms": { "maternal": [ "pregnancy" ] }, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Women not previously found to have overt diabetes or gestational diabetes in this pregnancy" ], "exclusion": [ "Not stated in the PubMed abstract" ] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "limitations": "This is a consensus panel recommendation from 2010 (Diabetes Care). The panel says that its recommendations for detecting overt diabetes in pregnancy rest on the opinions of its members, because prospective studies or suitable trials are not available. The threshold values are in the article tables and are not restated here because the table text could not be quoted word for word. The USPSTF statement of 2021 does not choose a test, and the ScreenR2GDM trial compared this kind of one-step test with a two-step approach; neither source ties the trial’s one-step arm to the IADPSG criteria, so the atlas does not either. Only the PMC full text was read, not the supplemental tables.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Table 2, 24–28 weeks gestation", "applicability_note": "IADPSG report, PMC full text (CC BY-NC-ND 3.0); short quotation with attribution.", "snapshot": { "id": "maternal:pmc-pmc2827530-2026-10-14", "retrieved_at": "2026-10-14T18:18:42Z", "content_hash": "3447c11ed65bf43b46778d02454495f46e65dd4883103ebc51e299659e0a5851", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pmc-pmc2827530", "source_type": "publication", "title": "International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy", "canonical_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2827530/", "identifiers": [ { "scheme": "pmcid", "value": "PMC2827530", "normalized_value": "PMC2827530", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "20190296", "normalized_value": "20190296", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "doi", "value": "10.2337/dc09-1848", "normalized_value": "10.2337/dc09-1848", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": null, "publisher": "Diabetes Care", "edition": "PMC full text (efetch XML) of the Diabetes Care article, fetched 2026-10-14. PubMed holds no abstract for this record. The PubMed record of the same article (PMID 20190296) holds no abstract; its snapshot is kept here.", "reuse_basis": "The article states the licence CC BY-NC-ND 3.0 (readers may use it as long as the work is properly cited, the use is educational and not for profit, and the work is not altered). The XML is not committed; only its sha256 is kept. Quotations stay at 24 words or fewer, with the citation.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Table 1, footnote", "applicability_note": "IADPSG report, PMC full text (CC BY-NC-ND 3.0); short quotation with attribution.", "snapshot": { "id": "maternal:pmc-pmc2827530-2026-10-14", "retrieved_at": "2026-10-14T18:18:42Z", "content_hash": "3447c11ed65bf43b46778d02454495f46e65dd4883103ebc51e299659e0a5851", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pmc-pmc2827530", "source_type": "publication", "title": "International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy", "canonical_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2827530/", "identifiers": [ { "scheme": "pmcid", "value": "PMC2827530", "normalized_value": "PMC2827530", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "20190296", "normalized_value": "20190296", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "doi", "value": "10.2337/dc09-1848", "normalized_value": "10.2337/dc09-1848", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": null, "publisher": "Diabetes Care", "edition": "PMC full text (efetch XML) of the Diabetes Care article, fetched 2026-10-14. PubMed holds no abstract for this record. The PubMed record of the same article (PMID 20190296) holds no abstract; its snapshot is kept here.", "reuse_basis": "The article states the licence CC BY-NC-ND 3.0 (readers may use it as long as the work is properly cited, the use is educational and not for profit, and the work is not altered). The XML is not committed; only its sha256 is kept. Quotations stay at 24 words or fewer, with the citation.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Summary of detection strategy, early pregnancy", "applicability_note": "IADPSG report, PMC full text (CC BY-NC-ND 3.0); short quotation with attribution.", "snapshot": { "id": "maternal:pmc-pmc2827530-2026-10-14", "retrieved_at": "2026-10-14T18:18:42Z", "content_hash": "3447c11ed65bf43b46778d02454495f46e65dd4883103ebc51e299659e0a5851", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pmc-pmc2827530", "source_type": "publication", "title": "International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy", "canonical_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2827530/", "identifiers": [ { "scheme": "pmcid", "value": "PMC2827530", "normalized_value": "PMC2827530", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "20190296", "normalized_value": "20190296", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "doi", "value": "10.2337/dc09-1848", "normalized_value": "10.2337/dc09-1848", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": null, "publisher": "Diabetes Care", "edition": "PMC full text (efetch XML) of the Diabetes Care article, fetched 2026-10-14. 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Quotations stay at 24 words or fewer, with the citation.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Introduction, last paragraph", "applicability_note": "Basis of the recommendations in the HAPO study and in panel opinion.", "snapshot": { "id": "maternal:pmc-pmc2827530-2026-10-14", "retrieved_at": "2026-10-14T18:18:42Z", "content_hash": "3447c11ed65bf43b46778d02454495f46e65dd4883103ebc51e299659e0a5851", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pmc-pmc2827530", "source_type": "publication", "title": "International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy", "canonical_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2827530/", "identifiers": [ { "scheme": "pmcid", "value": "PMC2827530", "normalized_value": "PMC2827530", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "20190296", "normalized_value": "20190296", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "doi", "value": "10.2337/dc09-1848", "normalized_value": "10.2337/dc09-1848", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": null, "publisher": "Diabetes Care", "edition": "PMC full text (efetch XML) of the Diabetes Care article, fetched 2026-10-14. PubMed holds no abstract for this record. The PubMed record of the same article (PMID 20190296) holds no abstract; its snapshot is kept here.", "reuse_basis": "The article states the licence CC BY-NC-ND 3.0 (readers may use it as long as the work is properly cited, the use is educational and not for profit, and the work is not altered). The XML is not committed; only its sha256 is kept. Quotations stay at 24 words or fewer, with the citation.", "public_text": "quote" } } ], "review": { "content_digest": "0f7fe6d4d4dff2d4a6087459d65060115614f5648b31f1cd4c4bd367a5d19d0f", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-iadpsg-75g-ogtt-24-28-weeks.json" }, { "release_id": "c7fb95f1d15a7d13", "id": "maternal:claim-screenr2gdm-infant-outcomes", "owner": "maternal", "subject_entity_id": "maternal:gdm-glucose-screening-test", "category": "effect", "statement": "In ScreenR2GDM, in intention-to-treat analyses, the incidence of large-for-gestational-age infants was 8.9% with one-step screening and 9.2% with two-step screening (relative risk 0.95, 97.5% CI 0.87 to 1.05). The incidence of the perinatal composite outcome (stillbirth, neonatal death, shoulder dystocia, bone fracture, or any arm or hand nerve palsy related to birth injury) was 3.1% and 3.0% (relative risk 1.04, 97.5% CI 0.88 to 1.23). The authors report no significant between-group differences in these primary outcomes, although one-step screening diagnosed gestational diabetes about twice as often.", "context": { "id": "maternal:ctx-screenr2gdm-infants-of-screened-women", "label": "Infants born to women in the ScreenR2GDM trial", "recipient": "mixed", "population": "Infants born to the women in the ScreenR2GDM trial. The outcomes in this context are large-for-gestational-age infants and a perinatal composite (stillbirth, neonatal death, shoulder dystocia, bone fracture, or any arm or hand nerve palsy related to birth injury). The composite includes deaths before or around birth, so the context covers fetuses and newborns and is not split by recipient.", "care_setting": "Two health systems (pragmatic trial); the abstract does not describe the settings further.", "geography": "Not stated in the PubMed abstract", "life_stage_note": "Birth and the perinatal period", "life_stage_terms": { "maternal": [ "pregnancy", "newborn" ] }, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Perinatal period, as the composite is defined", "eligibility": { "inclusion": [ "Infants of the women in the trial" ], "exclusion": [ "Not stated in the PubMed abstract" ] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "limitations": "The abstract gives incidences without denominators, so none are recorded. Adherence to the assigned screening differed (66% in the one-step group and 92% in the two-step group), and the abstract says results were materially unchanged with inverse probability weighting. The comparison is of whole pathways, as the treatment guidelines matched each screening approach. Only the PubMed abstract was read.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, RESULTS, sentence 4", "applicability_note": "PubMed abstract of the NEJM 2021 report.", "snapshot": { "id": "maternal:pubmed-33704936-2026-10-14", "retrieved_at": "2026-10-14T18:18:21Z", "content_hash": "3065c718588de479f058b8495cf371136936b740d0109d8bfaebd5cfb2b38a69", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pubmed-10-1056-nejmoa2026028", "source_type": "publication", "title": "A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening", "canonical_url": "https://doi.org/10.1056/NEJMoa2026028", "identifiers": [ { "scheme": "doi", "value": "10.1056/NEJMoa2026028", "normalized_value": "10.1056/nejmoa2026028", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "33704936", "normalized_value": "33704936", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC9041326", "normalized_value": "PMC9041326", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2021-03-11", "publisher": "The New England journal of medicine", "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. 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The full text and the version of record were not fetched.", "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.", "public_text": "quote" } } ], "review": { "content_digest": "c96e6e4af0591cc43c83e08a86040d80ff406b5f5fb030a63d025f7c982cb995", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-screenr2gdm-infant-outcomes.json" }, { "release_id": "c7fb95f1d15a7d13", "id": "maternal:claim-screenr2gdm-maternal-outcomes", "owner": "maternal", "subject_entity_id": "maternal:gdm-glucose-screening-test", "category": "effect", "statement": "In ScreenR2GDM, a pragmatic randomized trial in all pregnant women who received care in two health systems, 23,792 women underwent randomization. One-step screening (a 75-g glucose load in the fasting state) diagnosed gestational diabetes in 16.5% of the women assigned to it and two-step screening (a 50-g load in the nonfasting state, then a 100-g load in the fasting state if positive) in 8.5% (unadjusted relative risk 1.94, 97.5% CI 1.79 to 2.11). Adherence to the assigned screening was 66% in the one-step group and 92% in the two-step group. For the women, gestational hypertension or preeclampsia occurred in 13.6% (one-step) and 13.5% (two-step) (relative risk 1.00, 97.5% CI 0.93 to 1.08), and primary cesarean section in 24.0% and 24.6% (relative risk 0.98, 97.5% CI 0.93 to 1.02). The authors report no significant between-group differences in the primary outcomes relating to perinatal and maternal complications.", "context": { "id": "maternal:ctx-screenr2gdm-women-in-two-health-systems", "label": "Pregnant women who received care in two health systems (ScreenR2GDM trial)", "recipient": "maternal", "population": "All pregnant women who received care in two health systems. 23,792 women underwent randomization; women with more than one pregnancy during the trial could be assigned to more than one type of screening.", "care_setting": "Two health systems (pragmatic trial); the abstract does not describe the settings further.", "geography": "Not stated in the PubMed abstract", "life_stage_note": "Pregnancy, screening for gestational diabetes", "life_stage_terms": { "maternal": [ "pregnancy" ] }, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Until delivery outcomes (diagnosis, hypertensive disorders, cesarean section)", "eligibility": { "inclusion": [ "All pregnant women who received care in two health systems" ], "exclusion": [ "Not stated in the PubMed abstract" ] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "limitations": "The trial compares whole pathways: the abstract says treatment guidelines were consistent with each screening approach, so differences or the lack of them reflect screening plus the treatment each approach triggers. Adherence differed (66% and 92%); the abstract says results were materially unchanged in intention-to-treat analyses with inverse probability weighting for differential adherence. The abstract does not give the numbers of women analysed in each group or the follow-up period, so no denominators are recorded. Only the PubMed abstract was read; the full text is not in the PMC open access subset.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, RESULTS, sentence 1", "applicability_note": "PubMed abstract of the NEJM 2021 report.", "snapshot": { "id": "maternal:pubmed-33704936-2026-10-14", "retrieved_at": "2026-10-14T18:18:21Z", "content_hash": "3065c718588de479f058b8495cf371136936b740d0109d8bfaebd5cfb2b38a69", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pubmed-10-1056-nejmoa2026028", "source_type": "publication", "title": "A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening", "canonical_url": "https://doi.org/10.1056/NEJMoa2026028", "identifiers": [ { "scheme": "doi", "value": "10.1056/NEJMoa2026028", "normalized_value": "10.1056/nejmoa2026028", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "33704936", "normalized_value": "33704936", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC9041326", "normalized_value": "PMC9041326", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2021-03-11", "publisher": "The New England journal of medicine", "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. 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It grades this a B recommendation and concludes with moderate certainty that there is a moderate net benefit to screening for gestational diabetes at 24 weeks of gestation or after to improve maternal and fetal outcomes.", "context": { "id": "maternal:ctx-uspstf-2021-asymptomatic-pregnant-persons-at-24-weeks-or-after", "label": "Asymptomatic pregnant persons at 24 weeks of gestation or after (USPSTF 2021)", "recipient": "maternal", "population": "Asymptomatic pregnant persons who have not been previously diagnosed with type 1 or type 2 diabetes, at 24 weeks of gestation or after.", "care_setting": "Not stated in the PubMed abstract", "geography": "United States (statement of the US Preventive Services Task Force); the abstract names no country.", "life_stage_note": "Pregnancy, 24 weeks of gestation or after", "life_stage_terms": { "maternal": [ "pregnancy" ] }, "gestational_age_min_days": 168, "gestational_age_max_days": null, "gestational_age_basis": "at_measurement", "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Asymptomatic pregnant persons at 24 weeks of gestation or after" ], "exclusion": [ "Not stated in the PubMed abstract" ] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "limitations": "The recommendation is for screening in general. It does not choose between the one-step and two-step tests, which is why it is linked to the page on glucose tests. PubMed links a published erratum (PMID 34609473, titled Incorrect Value in Table); its PubMed and PMC records hold only the title and no correction text (the correction is in the journal PDF, which was not fetched), so whether it changes anything in this claim is not known. The PubMed abstract prints each grade after its statement, so the B appears at the start of the next sentence. USPSTF certainty levels are the task force’s own wording and not a GRADE rating. 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