Syed et al. BMC Public Health 2011, 11(Suppl 3):S2 http://www.biomedcentral.com/1471-2458/11/S3/S2 Page 4 of 12 Screened titles and abstracts Detailed review Screening for relevant outcomes Ante-partum Stillbirths 2162 titles identified through a PubMed based search. 261 articles reviewed for eligibility. A total of 70 articles selected for data extraction after adding articles from hand searched bibliographies. Intrapartum Stillbirths Perinatal Mortality Figure 1 Synthesis of literature search in this review of the effect of detection and management of maternal diabetes mellitus on perinatal mortality as an outcome of pregnancy. (1) a. Impact of early detection strategies versus late detection of GDM in pregnancy A single cohort study [38] compared early testing (before 24 weeks) versus regular schedule (i.e. glucose challenge test/OGTT between 24th to 28th week of gestation) of testing in a group of women with a history of GDM in prior pregnancy. This study was unable to show that early testing was better than late testing in improving perinatal mortality. This is supported by a review by Hillier et al. [81] that also did not find any randomized trials evaluating risks or benefits of early detection. (1) b. Other screening strategies Two other observational studies focused on screening of diabetes using different criteria. The cohort study by Schmidt et al 2001 [68] compared two sets of screening criteria for GDM; ADA (American Diabetic Association criteria) versus WHO criteria. There were a total of 13 deaths (7 fetal deaths and 6 early neonatal deaths) with no difference using either set of criteria (ADA criteria: RR 3.1,95 CI% 1.42-6.47; WHO criteria: RR 1.59, 95% CI 0.86-2.90). A study by Ezimokhai et al 2006 [40] compared effect of universal screening (2001-2002) ver- sus selective screening (1996-1997) of high risk candi- dates. No significant difference in intrauterine fetal death was observed (RR 0.42, 95% CI 0.16 -1.12) between either groups. (2) Outpatient versus hospital based monitoring and management Two observational studies focusing on hospital based versus outpatient monitoring were retrieved in our search. A controlled prospective trial by Nachum et al. [62] on pregestational and gestational diabetics com- pared ambulatory monitoring versus repeat hospitaliza- tions. No difference in effect on risk of perinatal mortality or neonatal mortality was observed (RR 0.98,