{
  "abstract": "Background\n\nGestational diabetes mellitus (GDM) screening practices remain debated. One-step strategies identify more women with GDM, but their population-level benefits remain uncertain. Belgium provides a natural experiment: Wallonia recommended screening with the one-step strategy based on IADPSG criteria in 2012, whereas Flanders continued to recommend a two-step approach.Objective\n\nTo compare changes in birthweight-related outcomes and recorded hyperglycaemia in pregnancy (HiP) between these regions after their screening recommendations diverged.Methods\n\nWe conducted a population-based study including all singleton live births in Wallonia and Flanders during 2010-2011, before the adoption of one-step screening recommendations in Wallonia (n = 211,774), and during 2015-2018 (n = 399,376)., after a transitional implementation period ( between 2012 and 2014). HiP was defined as recorded gestational or pre-existing diabetes. Crude prevalences were calculated by region and period. Logistic and multinomial logistic models estimated changes in HiP, small-for-gestational-age (SGA), large-for-gestational-age (LGA), and macrosomia. Adjusted ratios of odds ratios (aRORs) compared post-versus-pre changes in Wallonia with those in Flanders, accounting for maternal sociodemographic characteristics, body mass index, and parity.Results\n\nHiP prevalence increased from 2.74% to 4.29% in Flanders and from 5.95% to 8.52% in Wallonia. However, the relative increase was smaller in Wallonia than in Flanders (aROR 0.92, 95% CI 0.87-0.97). The prevalence of SGA decreased from 6.54% to 5.72% in Flanders and from 8.60% to 8.09% in Wallonia, with a smaller relative decrease in Wallonia (aROR 1.11, 95% CI 1.05-1.15). No differential change between regions was observed for LGA (aROR 1.00, 95% CI 0.97-1.04). Macrosomia remained broadly stable in both regions (9.29-9.16% in Flanders and 6.19-6.51% in Wallonia), although a trivial differential change was observed (aROR 1.05, 95% CI 1.00-1.09).Conclusions\n\nAlthough the absolute increase in HiP prevalence was greater in Wallonia, the relative increase in the odds of HiP was smaller than in Flanders, where two-step screening recommendations were maintained. No consistent improvement in birthweight-related outcomes was observed. These findings suggest that changes in screening recommendations may not translate into clinically meaningful population-level changes, although we cannot exclude challenges in their implementation and uptake in clinical practice.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Gynaecology and Obstetrics, Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium.",
    "Belgian Helathcare Knowledge Centre (KCE), Brussels, Belgium.",
    "Department of Gynaecology and Obstetrics, Universitair Ziekenhuis Brussels (UZB), Brussels, Belgium.",
    "Research Center in Health Systems and Policies, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Elena Costa",
      "orcid": "0000-0002-4044-9799"
    },
    {
      "affs": [
        1
      ],
      "name": "Christophe de Meester"
    },
    {
      "affs": [
        0
      ],
      "name": "An Vercoutere",
      "orcid": "0000-0002-4802-308X"
    },
    {
      "affs": [
        0
      ],
      "name": "Sophie Alexander"
    },
    {
      "affs": [
        2
      ],
      "name": "Michel Boulvain",
      "orcid": "0000-0001-9536-3071"
    },
    {
      "affs": [
        0
      ],
      "name": "Sara Derisbourg"
    },
    {
      "affs": [
        0
      ],
      "name": "Clotilde Lamy",
      "orcid": "0000-0001-5015-7987"
    },
    {
      "affs": [
        0
      ],
      "name": "Anne Delbaere",
      "orcid": "0000-0001-7236-0687"
    },
    {
      "affs": [
        3
      ],
      "name": "Judith Racapé"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bfa335ftm7g88.bib",
  "cited_by": 0,
  "doi": "10.1016/j.eurox.2026.100502",
  "fulltext_url": "https://europepmc.org/articles/PMC13694808",
  "id": "bfa335ftm7g88",
  "issns": [
    "2590-1613"
  ],
  "landing_url": "https://europepmc.org/article/MED/42926839",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2729|Gestational Diabetes Research and Management"
    ]
  ],
  "openalex": "W7221548746",
  "pdf_url": "https://europepmc.org/articles/PMC13694808?pdf=render",
  "pmcid": "PMC13694808",
  "pmid": "42926839",
  "published": "2026-10-12",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/bfa335ftm7g88.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:18Z",
      "native_id": "MED:42926839",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42926839"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2729|Gestational Diabetes Research and Management",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Regional one-step and two-step gestational diabetes screening recommendations and birthweight outcomes in Belgium: A population-based controlled before-after study.",
  "title_text": "Regional one-step and two-step gestational diabetes screening recommendations and birthweight outcomes in Belgium: A population-based controlled before-after study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:18Z",
  "url": "https://research.draconitic.com/paper/bfa335ftm7g88",
  "venue": "European journal of obstetrics & gynecology and reproductive biology: X",
  "versions": []
}