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Gestational Diabetes: Strong Support for Treatment

An intervention of dietary counseling, home glucose monitoring, and treatment as needed reduced adverse perinatal and maternal outcomes.

In this clinical trial, investigators in Australia and the U.K. evaluated the maternal and perinatal effects of treating gestational diabetes. Women with singleton or twin pregnancies who met criteria for gestational diabetes at 24 to 34 weeks’ gestation (fasting serum glucose, <140 mg/dL; serum glucose 2 hours after 75-g oral glucose challenge, 140–198 mg/dL) were randomized to an intervention or to routine care. Women in the intervention group (N=490; mean age, 31; median BMI, 27) received individualized dietary counseling from a dietician, instructions for home monitoring of glucose levels, and insulin therapy as needed. In the routine-care group (N=510; mean age, 30; median BMI, 26), women received care as if they had not been screened, with further testing permitted if they showed signs of diabetes, and treatment as needed.

Insulin therapy was given to 20% and 3% of women in the intervention and routine-care groups, respectively. After adjustment for maternal age, race, and parity, the rate of serious adverse perinatal outcomes (death, shoulder dystocia, bone fracture, or nerve palsy) was significantly lower with the intervention than with routine care (1% vs. 4%). In addition, the mean birth weight and incidence of macrosomia (birth weight 4 kg) were significantly lower among infants in the intervention group, and intervention infants also were born at an earlier gestational age. The rate of labor induction was significantly higher in the intervention group, but rates of cesarean delivery were similar in the two groups. The mean maternal weight gain and incidence of preeclampsia were significantly lower in the intervention group.

Comment: With maternal obesity becoming more common in the U.S., the incidence of gestational diabetes is on the rise. In this country, it is conventional practice to screen for and treat gestational diabetes, but data to support this approach have been limited. These findings provide strong evidence that screening for and treating gestational diabetes reduces adverse perinatal outcomes without increasing rates of cesarean delivery. As editorialists point out, optimal diagnostic criteria need to be determined, but we can confidently proceed in treating women with gestational diabetes diagnosed according to current criteria.

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health July 19, 2005

Citation(s):

Crowther CA et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005 Jun 16; 352:2477-86.

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• Medline abstract (Free)

Greene MF and Solomon CG. Gestational diabetes mellitus — Time to treat. N Engl J Med 2005 Jun 16; 352:2544-6.

• Original article (Subscription may be required)
• Medline abstract (Free)