Abstract
ObjectivesIt is uncertain whether the treatment of mild gestational diabetes mellitus (GDM) improves pregnancy outcomes. The aim of this systemic review and meta-analysis was to investigate the effect of mild GDM treatment on adverse pregnancy outcomes.MethodsA comprehensive literature search was conducted on the databases of PubMed, Scopus, and Google Scholar to retrieve studies that compared interventions for the treatment of mild GDM with usual antenatal care. The fixed/random effects models were used for the analysis of heterogeneous and non-heterogeneous results. Publication bias was assessed using the Harbord test. Also, the DerSimonian and Laird, and inverse variance methods were used to calculate the pooled odds ratio of events. The quality assessment of the included studies was performed using the Modified Newcastle–Ottawa Quality Assessment scale and the CONSORT checklist. In addition, the risk of bias was evaluated using the Cochrane Collaboration’s tool for assessing risk of bias.ResultsThe systematic review and meta-analysis involved ten studies consisting of 3317 pregnant women who received treatment for mild GDM and 4407 untreated counterparts. Accordingly, the treatment of mild GDM significantly reduced the risk of macrosomia (OR = 0.3; 95%CI = 0.3–0.4), large for gestational age (OR = 0.4; 95%CI = 0.3–0.5), shoulder dystocia (OR = 0.3; 95%CI = 0.2–0.6), caesarean-section (OR = 0.8; 95%CI = 0.7–0.9), preeclampsia (OR = 0.4; 95%CI = 0.3–0.6), elevated cord C-peptide (OR = 0.7; 95%CI = 0.6–0.9), and respiratory distress syndrome (OR = 0.7; 95%CI = 0.5–0.9) compared to untreated counterparts. Moreover, the risk of induced labor significantly increased in the treated group compared to the untreated group (OR = 1.3; 95%CI = 1.0–1.6). However, no statistically significant difference was observed between the groups in terms of small for gestational age, hypoglycemia, hyperbilirubinemia, birth trauma, admission to the neonatal intensive care unit, and preterm birth. Sensitivity analysis based on the exclusion of secondary analysis data was all highly consistent with the main data analysis.ConclusionTreatment of mild GDM reduced the risk of selected important maternal outcomes including preeclampsia, macrosomia, large for gestational age, cesarean section, and shoulder dystocia without increasing the risk of small for gestational age. Nevertheless, the treatment could not reduce the risk of neonatal metabolic abnormalities or several complications in newborn.
Highlights
Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed in the second or third trimester of pregnancy without the presence of overt diabetes prior to gestation [1]
It has been suggested that mild GDM is associated with the increased perinatal risk [11,12,13], it is uncertain whether the treatment of hyperglycemia exerts a protective influence on perinatal outcomes among pregnant women with GDM
The objectives of this review were to assess: o the pooled risk of adverse single and composite maternal outcomes among those pregnant women who received the treatment of mild GDM compared to untreated counterparts; o the pooled risk of adverse single and composite neonatal outcomes among those pregnant women who received the treatment of mild GDM compared to untreated counterparts; o sensitivity analysis based on the exclusion of secondary analysis studies
Summary
Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed in the second or third trimester of pregnancy without the presence of overt diabetes prior to gestation [1]. GDM is one of the most common endocrinopathies among pregnant women and influences 4-12% of all pregnancies [2]. Previous studies have demonstrated that GDM is associated with the increased risk of adverse feto-maternal and neonatal outcomes [3, 4]. The Hyperglycemia and Adverse Pregnancy Outcomes’ (HAPO) study indicated that GDM is associated with the enhanced risk of adverse perinatal outcomes, without an obvious threshold at which the risk is increased [10]. It has been suggested that mild GDM is associated with the increased perinatal risk [11,12,13], it is uncertain whether the treatment of hyperglycemia exerts a protective influence on perinatal outcomes among pregnant women with GDM
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