Early versus Second-Trimester Screening and Treatment for Diabetes in Pregnancy

This editorial critiques a randomized trial by Simmons et al. comparing early (before 20 weeks) versus second-trimester (24–28 weeks) screening and treatment for gestational diabetes mellitus (GDM) in high-risk pregnancies. The trial, conducted across 17 hospitals in Australia, Austria, India, and Sweden, involved 802 women with risk factors (e.g., obesity, prior GDM). Early treatment reduced adverse neonatal outcomes (24.9% vs. 30.5%; adjusted RR 0.82), driven by fewer cases of respiratory distress, but showed no significant differences in pregnancy-related hypertension or neonatal lean body mass. The author questions the clinical impact of these modest benefits, contrasting them with the negative results of the EGGO trial, and challenges current guidelines recommending early screening for high risk women.

This editorial critiques a randomized trial by Simmons et al. comparing early (before 20 weeks) versus second-trimester (24–28 weeks) screening and treatment for gestational diabetes mellitus (GDM) in high-risk pregnancies. The trial, conducted across 17 hospitals in Australia, Austria, India, and Sweden, involved 802 women with risk factors (e.g., obesity, prior GDM). Early treatment reduced adverse neonatal outcomes (24.9% vs. 30.5%; adjusted RR 0.82), driven by fewer cases of respiratory distress, but showed no significant differences in pregnancy-related hypertension or neonatal lean body mass. The author questions the clinical impact of these modest benefits, contrasting them with the negative results of the EGGO trial, and challenges current guidelines recommending early screening for high risk women.