Fatima R. Alsharif

Background: Gestational diabetes mellitus (GDM), defined as hyperglycaemia first identified during pregnancy, is associated with increased risks of adverse maternal and neonatal outcomes. Standard screening is typically performed at 24–28 weeks’ gestation; however, earlier screening before 20 weeks has been proposed to improve outcomes. Evidence supporting early screening or diagnosis remains inconsistent. We aimed to evaluate whether early screening or early diagnosis of GDM (before 20 weeks) influences maternal and neonatal outcomes compared with standard screening or diagnosis at 24–28 weeks.Methods: We conducted a systematic review and meta-analysis of analytical studies comparing early versus standard timing of GDM screening or diagnosis. A systematic search of PubMed, Embase, Web of Science, and Cochrane CENTRAL was performed from inception to 2025. Eligible studies included those comparing early versus usual screening in unselected pregnant populations and/or early versus usual diagnosis among women with GDM; these comparisons were carefully predefined to minimize potential bias. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the MASTER scale. Pooled effects were generated using the quality-effects model. Publication bias was assessed using Doi plots. For binary outcomes, odds ratios were calculated and converted to absolute measures (risk differences and numbers needed to treat or harm) across a range of baseline risks to enhance interpretability. Outcomes assessed included gestational weight gain, preterm delivery, preeclampsia or eclampsia, macrosomia, neonatal hypoglycemia, neonatal intensive care unit admission, large-for-gestational-age infants, and caesarean delivery.Finding:14 studies met the inclusion criteria. Early diagnosis was not associated with a statistically divergent difference from usual diagnosis in terms of pregnancy-weight gain (WMD -1.08 kg), preterm delivery (OR 1.09), preeclampsia/eclampsia (OR 1.81), macrosomia (OR 0.97), PIH (OR 1.06), neonatal hypoglycemia (OR 1.61), NICU admission (OR 1.27), LGA (OR 0.98) and cesarean section (OR 1.18). Across the general obstetric population, early screening did not demonstrate a statistically divergent difference in any maternal or neonatal outcome including preterm delivery (OR 1.54), preeclampsia/eclampsia (OR 1.24), neonatal hypoglycemia (OR 1.19), Cesarean section (OR 0.87), macrosomia (OR 0.96) and LGA (OR 1.15). Translation of relative effects into absolute measures indicated no absolute clinical benefit for either early diagnosis or early screening. For early diagnosis, absolute risk differences were generally small and baseline-dependent, with directionally harmful effects for only few outcomes, particularly preeclampsia/eclampsia and neonatal hypoglycemia (NNH = 7 to 20), whereas most other outcomes demonstrated risk differences close to zero. Additionally, for early screening, absolute risk differences were largely neutral, with only preterm birth showing a small increase in absolute risk and all other outcomes indicating negligible differences.Interpretation: Early diagnosis of GDM does not identify a group with substantially different maternal and neonatal risks, likely reflecting a population for which intervention is unnecessary. Early screening, when applied to the general population of pregnant women, also does not improve outcomes and offers no absolute interventional benefit. Current evidence does

Background: There is ongoing debate about the ideal blood glucose thresholds for the diagnosis of gestational diabetes mellitus (GDM), as individual randomized controlled trials (RCTs) comparing the lower International Association of Diabetes and Pregnancy Study Groups (IADPSG) blood glucose to criteria which use higher blood glucose thresholds have not been conclusive.Objectives: This meta-analysis compared lower to higher blood glucose thresholds for GDM diagnosis in terms of GDM prevalence and adverse maternal and neonatal health outcomes.Methods: We searched Cochrane CENTRAL, PubMed, Scopus, CINAHL, and preprint archives up to May 30, 2025, for RCTs that compared lower to higher glucose thresholds in the diagnosis of GDM in pregnancy. Endpoints were GDM prevalence and adverse pregnancy outcomes. After study quality assessment, meta-analysis was done using an inverse variance heterogeneity model, heterogeneity was assessed using I2, and publication bias by funnel plots. The quality effects model was used to synthesize evidence that was presented using forest plots.Results: Ten RCTs, comparing IADPSG to higher blood glucose thresholds, with a total of 88,311 pregnant women, were included. After meta-analysis, the lower glycemic criteria compared to the higher glycemic criteria was associated with almost double the prevalence of GDM diagnosis (13.7% vs 8.04%, respectively) and the odds of GDM diagnosis (OR = 1.87, 95%CI 1.47-2.37, I2 = 93.4%), with moderate certainty GRADE evidence. For adverse pregnancy outcomes, the lower glycemic criteria compared to the higher glycemic criteria were associated with a trend towards lower odds for gestational hypertension (OR 0.57, 95%CI 0.30-1.07), and neonatal hypoglycemia (OR 0.35, 95%CI 0.06-1.93, I2=88.2%). However, there were no differences between the glycemic thresholds for cesarean section (OR 0.94, 95% 0.78-1.13, I2= 0%). For all the outcomes, there was low certainty GRADE evidence.Conclusion: While the lower glycemic threshold results in close to double the prevalence of GDM and potentially higher workload for the healthcare system, this meta-analysis suggests that there may not be a difference in maternal and fetal outcomes when using lower vs higher thresholds in diagnosing GDM. However, the very low to low GRADE certainty suggests that further RCTs are needed to improve the certainty of evidence.

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged as a global health crisis in early 2020, leading to widespread morbidity and mortality. In Qatar, as of December 2024, the disease burden has reached over 500,000 cases and more than 600 deaths. While conventional treatments have evolved throughout the pandemic, the use of Complementary and Alternative Medicine (CAM), particularly herbal medicine, has also become prevalent. This study investigated the prevalence, reasons, uses, types, self-reported benefits, and sociodemographic determinants of utilising herbal medicine among COVID-19 patients in Qatar. A cross-sectional study was conducted among patients attending Qatar Primary Health Care Corporation (PHCC) clinics. Of the 10,000 SMS invitations that were sent, 882 survey responses were received from patients diagnosed with COVID-19 between 1 March 2020, and 30th April 2022. Following the exclusion of 31 participants due to missing data, sociodemographic data from 851 participants were analysed using logistic regression to assess predictors of herbal medicine use. Prevalence, patterns, types, and self-reported benefits were analysed using descriptive statistics. Of the 851 respondents included in the analysis, 440 (51.7%) reported herbal medicine use. Herbal medicine use was associated with better-perceived health outcomes. Women were more likely to use herbal medicine than men (OR = 1.90, 95%CI: 1.30-2.77, p = 0.001). The most used herbal remedies were ginger (n = 347), turmeric (n = 207), and garlic (n = 155). Family tradition (42%), the belief that herbs are natural (34.8%), and the desire to improve health and survival (31.1%) were the leading drivers of herbal medicine use. Herbal medicine use was prevalent (51.7%) during COVID-19 in Qatar, with a higher prevalence of use among women. This prevalence was driven by cultural beliefs and perceived health benefits. The study contributes insights to guide future research, policy, and practice toward safe and evidence-informed integration of herbal medicine in pandemic preparedness and broader healthcare strategies.