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In general, a screening program is cost-effective (C-E) or even dominant over no screening. The 1-step screening, with more cases detected, is more likely to be C-E than the 2-step screening. Universal screening is more likely to be C-E than screening targeting the high-risk population. Parameters affecting cost-effectiveness include diagnosis criteria, epidemiological characteristics of the population, efficacy of screening and treatment, and costs. Conclusions Most studies found GDM screening to be cost-effective, though uncertaintie