Screening for gestational diabetes: variation in guidelines

Objective: To compare published guidelines concerning screening for gestati onal diabetes. Study design: Systematic search and comparative analysis of published guidelines. Appraisal of guidelines quality. Simulation analysis. Results: Ten published guidelines proposed either universal screening (5), selective screening (3) or screening when clinically indicated (2). Variat ions of testing schedules and blood glucose thresholds were observed. The q uality of the published guidelines was low, on average 22 (8-51) percentage points on the assessment scale. These differences would have led to large variations in the number of patients to be screened. Conclusions: Large var iations between guidelines have been observed which would translate in larg e practice variations, if the guidelines were systematically applied. These variations are partially explained by the absence of definite evidence tha t universal or selective screening for gestational diabetes do more good th an harm on infant and maternal health. The methodology of developing guidel ines should be more evidence based, systematic and explicit. (C) 2000 Elsev ier Science Ireland Ltd. All rights reserved.