Maternal & Newborn Atlas
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No single agreed way to diagnose gestational diabetes

Doctors use two main ways to test for gestational diabetes, a one-step and a two-step approach, and they do not label the same women. In a large US trial, about 16.5% of women were diagnosed with the one-step approach and about 8.5% with the two-step approach. The trial found no significant difference in the main pregnancy outcomes between the two, so it is still debated which approach is better.

  • Bottleneck
  • In this atlas

Overview

Technical summary

The ScreenR2GDM abstract (NEJM 2021) states that experts recommend universal screening but that consensus is lacking on which of the two recommended approaches to use. Diagnosis rates were 16.5% and 8.5% (unadjusted relative risk 1.94, 97.5% CI 1.79 to 2.11); adherence to the assigned approach was 66% and 92%; the primary outcomes did not differ significantly. The IADPSG consensus report recommends a one-step 75-g test; a 2021 US screening statement does not choose a test. Current efforts listed are the screening test page and that statement.

Scope

Pregnant people tested for gestational diabetes; the criteria differ between professional bodies and health systems.

Stage
Screening and diagnosis at 24 to 28 weeks of gestation
Why it is severe
The approach chosen changes how many women are diagnosed (16.5% against 8.5% in one trial), and so how many are treated, yet the trial found no significant difference in the primary pregnancy outcomes.

Burden

  • Effect Interventional Certainty not assessed

    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.

    Applies to Maternal
    • 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.
    • Two health systems (pragmatic trial); the abstract does not describe the settings further.
    • Not stated in the PubMed abstract
    • Pregnancy, screening for gestational diabetes
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Until delivery outcomes (diagnosis, hypertensive disorders, cesarean section)
    Certainty method
    Not assessed
    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.
    Last checked
    2026-10-14
    Next evidence check due
    Not scheduled
    Sources and citations (8)

    1. Supports A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-03-11 · DOI: 10.1056/NEJMoa2026028 · PMID: 33704936 · PMCID: PMC9041326

      Locator
      Abstract, RESULTS, sentence 1
      How it applies
      PubMed abstract of the NEJM 2021 report.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3065c718588de479f058b8495cf371136936b740d0109d8bfaebd5cfb2b38a69
      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.

    2. Supports A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-03-11 · DOI: 10.1056/NEJMoa2026028 · PMID: 33704936 · PMCID: PMC9041326

      Locator
      Abstract, RESULTS, sentence 2
      How it applies
      PubMed abstract of the NEJM 2021 report.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3065c718588de479f058b8495cf371136936b740d0109d8bfaebd5cfb2b38a69
      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.

    3. Supports A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-03-11 · DOI: 10.1056/NEJMoa2026028 · PMID: 33704936 · PMCID: PMC9041326

      Locator
      Abstract, RESULTS, sentence 3
      How it applies
      PubMed abstract of the NEJM 2021 report.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3065c718588de479f058b8495cf371136936b740d0109d8bfaebd5cfb2b38a69
      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.

    4. Supports A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-03-11 · DOI: 10.1056/NEJMoa2026028 · PMID: 33704936 · PMCID: PMC9041326

      Locator
      Abstract, RESULTS, sentence 4
      How it applies
      PubMed abstract of the NEJM 2021 report.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3065c718588de479f058b8495cf371136936b740d0109d8bfaebd5cfb2b38a69
      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.

    5. Supports A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-03-11 · DOI: 10.1056/NEJMoa2026028 · PMID: 33704936 · PMCID: PMC9041326

      Locator
      Abstract, RESULTS, sentence 5
      How it applies
      PubMed abstract of the NEJM 2021 report.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3065c718588de479f058b8495cf371136936b740d0109d8bfaebd5cfb2b38a69
      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.

    6. Background A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-03-11 · DOI: 10.1056/NEJMoa2026028 · PMID: 33704936 · PMCID: PMC9041326

      Locator
      Abstract, METHODS, sentence 1
      How it applies
      Design, the treatment link and the authors’ conclusion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3065c718588de479f058b8495cf371136936b740d0109d8bfaebd5cfb2b38a69
      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.

    7. Background A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-03-11 · DOI: 10.1056/NEJMoa2026028 · PMID: 33704936 · PMCID: PMC9041326

      Locator
      Abstract, METHODS, sentence 2
      How it applies
      Design, the treatment link and the authors’ conclusion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3065c718588de479f058b8495cf371136936b740d0109d8bfaebd5cfb2b38a69
      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.

    8. Background A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, fetched 2026-10-14. The full text and the version of record were not fetched. · Published 2021-03-11 · DOI: 10.1056/NEJMoa2026028 · PMID: 33704936 · PMCID: PMC9041326

      Locator
      Abstract, CONCLUSIONS, sentence 1
      How it applies
      Design, the treatment link and the authors’ conclusion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      3065c718588de479f058b8495cf371136936b740d0109d8bfaebd5cfb2b38a69
      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.

Current efforts

Record details

Record id
maternal:bottleneck-gdm-diagnostic-criteria
Content hash
50502d93fc1532cb7ba4f59aeecda26a80308440a22dcc804e19719a19d2e8c2