Early Treatment of Gestational Diabetes Mellitus and Prediabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials [ID: 1377137

Abstract

INTRODUCTION: This meta-analysis aims to determine whether early treatment of hyperglycemia in gestational diabetes mellitus (GDM) and prediabetic pregnancies improve perinatal outcomes. METHODS: PubMed/Medline, EMBASE, ClinicalTrials.gov and Web of Science were systematically searched up to June 30, 2022. Randomized clinical trials (RCTs) of early treatment for gestational diabetes mellitus (International Association of the Diabetes and Pregnancy Study Groups [IADPSG] or Carpenter and Coustan [C&C] criteria) and prediabetes (HbA1c 5.7–6.4%) before 20 weeks of gestation were considered eligible. Random-effects model meta-analysis was used to pool the odds ratios (OR) and/or mean differences (MD) with 95% CI. Furthermore, subgroup analysis was performed stratifying by indication for intervention (GDM versus prediabetic). RESULTS: Seven RCTs including 2,757 pregnant individuals, of whom 647 had positive screening before 20 weeks of gestation, were included. Of 647 individuals, 346 were allocated to early treatment and 301 to the routine treatment. There was no significant difference in terms of gestational age at delivery (MD –0.21 [95% CI: −0.44, 0.02], P=.089), rate of cesarean delivery (OR 0.93 [95% CI: 0.64, 1.34], P=.394), hypertensive disorder of pregnancy (OR 1.19 [95% CI: 0.59, 2.39], P=.341), any diabetic medication use (OR 1.31 [95% CI: 0.89, 1.93], P=.177), and neonatal hypoglycemia (OR 1.02 [95% CI: 0.50, 2.08], P=.952). However, there was a decreased risk of macrosomia (OR 0.42 [95% CI: 0.19, 0.92], P=.031) and increased need for insulin use (OR 2.23 [95% CI: 1.30, 3.84], P=.004) for early treatment group. After separate analyses on GDM and prediabetics as distinct groups, the risk of macrosomia was not decreased for GDM and prediabetic subgroups after early treatment. CONCLUSION: Treatment in early pregnancy for GDM or prediabetes does not appear to improve the maternal or neonatal outcomes.