Screening for gestational diabetes mellitus: a decision and cost-effectiveness analysis of four screening strategies.

G estational diabetes mellitus (GDM), defined as carbohydrate intolerance of variable degree with onset or first recognition during pregnancy, is the most common medical condition of pregnancy. GDM affects 190,000 (4–5%) of the 4 million births occurring annually in the U.S. and is associated with several maternal and infant complications (1). Worldwide, the three primary screening strategies for GDM are the sequential strategy (initial 50-g glucose challenge test followed by, in those who test positive, a 100-g glucose tolerance test [GTT]), the 75-g GTT strategy, and the 100-g GTT strategy (2). The efficacy of these strategies, however, is debated. There are few randomized trials on the effectiveness of GDM screening (3). Yet, the majority of U.S. obstetricians provide universal screening for GDM (4). We conducted a cost-effectiveness analysis to compare four screening strategies for universal screening of GDM, including the sequential strategy, the 75and 100-g GTT, and a no-screening strategy. We assessed the relative cost and effectiveness (quality-adjusted life-years [QALYs]) of each strategy relative to the sequential strategy using a decision model.