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Treatment of Mild GDM Improves Pregnancy Outcomes

A multicenter, randomized trial of treatment for mild gestational diabetes, by Mark B. Landon and colleagues. New England Journal of Medicine 361:1339–13448, 2009


What is the problem and what is known about it so far?

Gestational diabetes mellitus (GDM) is high blood glucose that starts during pregnancy in women who have never had diabetes. GDM usually goes away after pregnancy, but women who have had GDM are more likely to have it again in later pregnancies and are also more likely to get type 2 diabetes. Untreated very high blood glucose during pregnancy can lead to high birth weight, birth defects, and other complications. Whether milder GDM also causes such problems remains unknown.

Why did the researchers do this particular study?

The researchers wanted to find out whether treating women with mild GDM reduces complications in the women and their babies.

Who was studied?

The study included 958 pregnant women who had mild GDM.

How was the study done?

The women were divided into two groups. One group received standard pregnancy care. The other group got standard care plus diet therapy, blood glucose monitoring, and insulin therapy if necessary to control their mild GDM. The researchers then looked at how many babies born to women in each group died, had birth trauma, or developed jaundice, low blood glucose, or high insulin levels.

What did the researchers find?

There were no deaths in either group and no differences between groups in jaundice, low blood glucose, or high insulin levels. However, women receiving GDM treatment had fewer babies with high birth weights and high body fat levels, fewer cases of shoulder dystocia (difficult delivery caused by the baby being too big to fit through the birth canal), and fewer cesarean section deliveries than those not receiving GDM treatment. Women who had GDM treatment were also less likely to have blood pressure problems during their pregnancies.

What were the limitations of the study?

The researchers did not track blood glucose levels in the women who did not receive GDM treatment. Therefore, they could not tell whether the GDM treatment controlled glucose levels better than standard care alone.

What are the implications of the study

Although treatment of mild GDM may not reduce the frequency of deaths or some complications in the babies of women with GDM, it does help to prevent such babies from becoming too large, which can lead to problem deliveries, cesarean sections, and health concerns for the babies later in life.

FOR MORE INFORMATION

Gestational Diabetes

Treatment of Gestational Diabetes

Gestational Diabetes: What to Expect

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