Maternity versus non-maternity healthcare settings for the diagnosis of gestational diabetes or diabetes in pregnancy.
Nora Cryns, Julia Schroer, Anna H Noel-Storr et al.
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In 30 seconds
This Cochrane systematic review and meta-analysis assessed whether maternity or non-maternity healthcare settings affect screening and diagnosis of gestational diabetes or diabetes in pregnancy. It found one randomised trial involving 781 pregnant participants, evaluating screening for gestational diabetes only. Screening in a maternity setting may improve compliance with screening and follow-up guidelines compared with a non-maternity setting (risk ratio 1.69, 95% confidence interval 1.53 to 1.87; 781 participants). The review found no eligible non-randomised studies, and evidence for other outcomes was limited or uncertain.
Key findings
- Maternity-setting screening may increase compliance with screening and follow-up guidelines (risk ratio 1.69, 95% confidence interval 1.53 to 1.87; 781 participants; low-certainty evidence).
- Time to access antenatal diabetes care may be shorter in maternity settings (mean difference -4.70 days, 95% confidence interval -6.03 to -3.37; 690 participants; low-certainty evidence).
- Only one trial was included; it evaluated gestational diabetes screening and did not identify ongoing studies or studies awaiting classification.
Why it matters
The findings suggest that the setting in which screening is delivered may influence whether pregnant people complete screening and follow-up, as well as access to antenatal diabetes care. These service outcomes matter for implementing screening pathways, but the evidence base is too limited to establish effects on maternal or child health outcomes or to determine whether the findings apply to diabetes in pregnancy more broadly.
What to keep in mind
Evidence came from one trial. For outcomes other than screening compliance, analyses used per-protocol rather than original randomised groups, creating substantial sample-size disparities and largely nullifying the protections of randomisation. Evidence certainty was low for the reported service outcomes.