Screening on Gestational Diabetes Mellitus (GDM) - Which Way Do the New Studies Show? Review and Comment

Screening for gestational diabetes mellitus (GDM) is not carried out uniformly internationally. In Germany, all pregnant women are offered a two-stage screening, initially a 50-g pretest (not fasting), in the positive case followed by a 75-g oral glucose tolerance test (oGTT) over 2 hours (fasting). In 2021, two randomized screening studies were published in which one-stage screening without a pre-test was compared with two-stage screening. One-stage screening increases GDM prevalence 2.3-fold with no benefit for clinically relevant maternal and neonatal endpoints and at the cost of unnecessary pharmacotherapy and burden on caregiver resources. With two-stage screening, only 20 % of women need an oGTT. In addition, women prefer the two-stage strategy.