March 15, 2021
National Center for Health Research’s Public Comments on the United States Preventive Services Task Force’s Draft Recommendation Statement Regarding Screenings for Gestational Diabetes Mellitus
We are writing to express our views on the U.S. Preventive Services Task Force’s (USPSTF) draft recommendation statement regarding the screening for gestational diabetes mellitus (GDM).
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We support the USPSTF’s update to the 2014 recommendations for GDM screening in asymptomatic pregnant persons. We support the “B” grade recommendation for screening at 24 weeks of gestation or later, as the data continue to suggest that the benefits outweigh the harms with moderate certainty. However, ethnic and racial minorities, as well as women of lower socioeconomic status and women aged 30 and above, are at a higher risk for GDM and developing Type II Diabetes after delivery. We thus strongly support the USPSTF’s assessment that more research on the effects of GDM screening on populations defined by race/ethnicity, age, and other relevant socioeconomic factors is needed.
Further, there is only one RCT that studied the potential benefits and harms before 24 weeks gestation. At least one or two additional well conducted RCTs are needed to draw conclusions. For this reason, the “I” grade recommendation continues to be appropriate for screening before 24 weeks gestation.
To better assess the benefits and harms of screening before and after 24 weeks gestation, we also agree that randomized controlled trials are needed, as was noted in the recommendation. In particular, it is important to understand how GDM affects maternal health outcomes such as preeclampsia and hypertension, as well as long-term outcomes such as obesity in the mother and the child.
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