Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes

Abstract

Up to 9% of pregnancies reportedly are complicated by gestational diabetes, which carries substantial risks of both maternal and perinatal complications. It is not clear whether screening and treatment to control maternalglucose levels can lower these risks. In this randomized trial, 490 women at 24 to 34 weeks gestation who had gestational diabetes were assigned to receive dietary advice, have blood glucose monitoring, and receive insulin as needed. Another 510 women received routine care. The intervention and routine care groups were similar at the outset, although those having the intervention were older and less likely to be white or primiparous. More than 90% of women were considered to be at risk of gestational diabetes because of the results of an oral glucose challenge testing. Significantly fewer women in the intervention group than those given routine care had serious perinatal outcomes (1% vs 4%). These included death, shoulder dystocia, bone fracture, and nerve palsy. Thirty-four women had to be treated to prevent a serious perinatal outcome. More infants born to intervention group women were admitted to a neonatal nursery. Labor was induced significantly more often in the intervention group than in the routine care group (39% vs 29%). Rates of cesarean delivery were similar. Assessments of women's health status showed trends favoring the intervention group. Less frequent postnatal depression was an example. All 5 perinatal deaths were in the routine care group. Birth weights were significantly lower in the intervention group, and these infants were born at earlier gestational ages. Fewer intervention infants were large for gestational age at birth and fewer had macrosomia (birth weight of 4 kg or greater). Women having the intervention had fewer antenatal clinic visits than did those given routine care, but more physician visits. These findings indicate that treating gestational diabetes lowers the risk of serious perinatal complications without at the same lime increasing the rate of cesarean delivery.