Screening and active management reduced perinatal complications more than routine care in gestational diabetes.

M e t h o d s Design: Randomized controlled trial (Australian Carbohydrate Intolerance Study in Pregnant Women [ACHOIS]). Allocation: {Concealed}†.* Blinding: Blinded {outcome assessors, data analysts, and data safety and monitoring committee; outcome assessors for shoulder dystocia were not blinded}†.* Follow-up period: Birth to hospital discharge. Setting: 16 hospitals in Australia. Patients: 1000 women (mean age 30 y) with a singleton or twin pregnancy at 16to 30weeks gestation and ≥ 1 risk factor for GDM on selective screening or a positive 50-g glucose-challenge test (GCT) result, and a 75-g oral glucose tolerance test at 24to 34-weeks gestation with fasting glucose < 7.8 mmol/L after an overnight fast and 7.8 to 11.0 mmol/L (140 to 198 mg/dL) at 2 hours. Intervention: A screening and active management intervention (routine screening and treatment for GDM by the obstetric team, dietary counseling, glucose self-monitoring, and insulin therapy as needed to maintain glucose levels within the recommended range) (n = 490), or routine care (women and their caregivers were not aware of the diagnosis of GDM) (n = 510). Outcomes: Neonatal outcomes included perinatal complications (a composite endpoint of death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, components of the composite endpoint, birth weight, large or small for gestational age, and macrosomia (≥ 4 kg). Maternal outcomes included need for induction of labor and cesarean delivery. Patient follow-up: 100% (women and infants) (intention-to-treat analysis).