Regional one-step and two-step gestational diabetes screening recommendations and birthweight outcomes in Belgium: A population-based controlled before-after study.
4 affiliations
- 1Department of Gynaecology and Obstetrics, Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium.
- 2Belgian Helathcare Knowledge Centre (KCE), Brussels, Belgium.
- 3Department of Gynaecology and Obstetrics, Universitair Ziekenhuis Brussels (UZB), Brussels, Belgium.
- 4Research Center in Health Systems and Policies, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Abstract
Background
Gestational 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
To compare changes in birthweight-related outcomes and recorded hyperglycaemia in pregnancy (HiP) between these regions after their screening recommendations diverged.Methods
We 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
HiP 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
Although 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.
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BibTeX
@article{costa2026regional,
title = {{Regional one-step and two-step gestational diabetes screening recommendations and birthweight outcomes in Belgium: A population-based controlled before-after study.}},
author = {Elena Costa and Christophe de Meester and An Vercoutere and Sophie Alexander and Michel Boulvain and Sara Derisbourg and Clotilde Lamy and Anne Delbaere and Judith Racapé},
journal = {European journal of obstetrics \& gynecology and reproductive biology: X},
year = {2026},
month = oct,
doi = {10.1016/j.eurox.2026.100502},
url = {https://europepmc.org/article/MED/42926839},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Regional one-step and two-step gestational diabetes screening recommendations and birthweight outcomes in Belgium: A population-based controlled before-after study.
AU - Elena Costa
AU - Christophe de Meester
AU - An Vercoutere
AU - Sophie Alexander
AU - Michel Boulvain
AU - Sara Derisbourg
AU - Clotilde Lamy
AU - Anne Delbaere
AU - Judith Racapé
PY - 2026
DA - 2026/10/12
JO - European journal of obstetrics & gynecology and reproductive biology: X
DO - 10.1016/j.eurox.2026.100502
UR - https://europepmc.org/article/MED/42926839
AB - Background Gestational 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 To compare changes in birthweight-related outcomes and recorded hyperglycaemia in pregnancy (HiP) between these regions after their screening recommendations diverged.Methods We 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 HiP 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 Although 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.
SN - 2590-1613
ER -