Bonomo, M. et al. Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance: a randomized clinical trial. Diabet. Med. 22, 1536-1541

Department of Obstetrics and Gynaecology, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore 3, 201621 Milan, Italy.
Diabetic Medicine (Impact Factor: 3.12). 12/2005; 22(11):1536-41. DOI: 10.1111/j.1464-5491.2005.01690.x
Source: PubMed


Most studies relating minor gestational metabolic alterations to macrosomia refer to glucose intolerance classified on the basis of the National Diabetes Data Group or previous World Health Organization diagnostic thresholds. Our aim was to evaluate the consequences of very mild forms of gestational glucose intolerance, defined by an elevated 50-g glucose challenge test followed by a normal oral glucose tolerance test, using the more restrictive Carpenter and Coustan's criteria (Borderline Gestational Glucose Intolerance, BGGI).
Three hundred BGGI women were randomly assigned to: Group A (standard management), Group B (dietary treatment and regular monitoring). A control group (C) was also considered. Newborns were classified as macrosomic, large (LGA), or small for gestational age (SGA).
The three groups were similar in age, body mass index and parity. Therapy in Group B significantly improved fasting (from 4.68 +/- 0.45 to 4.28 +/- 0.45 mmol/l) and 2-h postprandial glycaemia (from 6.01 +/- 0.57 to 5.13 +/- 0.68 mmol/l). Fasting glycaemia at delivery was significantly lower in B (4.20 +/- 0.38 mmol/l) than in A (4.84 +/- 0.45 mmol/l), and was also lower than in C (4.31 +/- 0.39 mmol/l). Significantly fewer LGA babies were born to Group B (6.0%) than Group A (14.0%) and Group C (9.1%). No difference was found in the SGA rate. The neonatal Ponderal Index was higher (P = 0.030) in group A (2.73 +/- 0.35) than in C (2.64 +/- 0.30) and B (2.64 +/- 0.24).
Even very mild alterations in glucose tolerance can result in excessive or disharmonious fetal growth, which may be prevented by simple, non-invasive therapeutic measures.


Available from: Antonio Ragusa
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    • "Of the ten studies included in the review, sequence generation was performed and described adequately in four studies only [17], [18], [20], [21]. Three studies were at high risk of bias for sequence generation as it was based on the days of week in one study [19],and in two studies, alternation was performed [23]. "
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    ABSTRACT: To assess the efficacy and safety of treating pregnant women with gestational diabetes mellitus in comparison to usual antenatal care. A systematic review and meta-analysis was conducted by including randomized controlled trials comparing any form of therapeutic intervention in comparison to usual antenatal care. A literature search was conducted using electronic databases together with a hand search of relevant journals and conference proceedings. Ten studies involving 3,881 patients contributed to meta-analysis. Our results indicated that gestational diabetes mellitus treatment significantly reduced the risk for macrosomia (RR, 0.47; 95% CI, 0.38-0.57), large for gestational age births (RR, 0.55; 95% CI, 0.45-0.67), shoulder dystocia (RR, 0.42; 95% CI, 0.23-0.77) and gestational hypertension (RR, 0.68; 95% CI, 0.53-0.87) without causing any significant increase in the risk for small for gestational age babies. However, no significant difference was observed between the two groups regarding perinatal/neonatal mortality, neonatal hypoglycemia, birth trauma, preterm births, pre-eclampsia, caesarean section and labor induction. Treating GDM reduces risk for many important adverse pregnancy outcomes and its association with any harm seems unlikely.
    PLoS ONE 03/2014; 9(3):e92485. DOI:10.1371/journal.pone.0092485 · 3.23 Impact Factor
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    • "These results do not however appear to have been controlled for any confounding variables. There has been only one small (150 women in each group) controlled trial [5] that stratified such women by age and BMI and that noted no significant difference between untreated women with positive GCT and negative GTT compared to controls with negative GCT, with regard to CS rate, macrosomia, admission to neonatal intensive care unit or in neonatal hypoglycaemia. There were significantly more newborns with a higher ponderal index among the cases. "

    Open Journal of Obstetrics and Gynecology 01/2014; 04(09):524-530. DOI:10.4236/ojog.2014.49074
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    • "It is well established that gestational diabetes causes increased fetal adiposity and high birth weight; therefore, most studies focus on large for gestational age (LGA) infants as an outcome of diabetic pregnancies [11]. However, increased birth weight is not restricted to diabetic pregnancies, as nondiabetic healthy mothers also deliver large babies, and maternal glucose variations, even within the normal range, may predict future metabolic risk [12] [13] [14]. A continuous debate remains regarding maternal factors that predict birth weight in healthy nondiabetic pregnancies with normal glucose tolerance [8] [15] [16]. "
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    ABSTRACT: Introduction: Increased neonatal birth weight (NBW), often associated with diabetic pregnancies, is a recognized indicator of childhood obesity and future metabolic risk. Predictors of NBW in healthy non-diabetic pregnancies are not yet established. Here, we investigated the association of maternal parameters of healthy non-diabetic mothers with NBW of their "appropriate-for-gestational age" neonates. Methods: The study involved 36 healthy mother/infant pairs. Examined parameters included NBW, maternal age, first and last trimester (BMI), weight gain, fasting serum lipids and glucose, 2-hour postload glucose levels and blood pressure. Results: Postload-glucose levels were significantly higher in mothers of heavier neonates. ANOVA results indicated that 15% increase in postload-glucose levels corresponded to more than 0.5 Kg increase in NBW in the third tertile. NBW correlated positively with postload glucose levels, and negatively with systolic blood pressure. Regression analysis showed that the main predictors of NBW were postload-glucose levels (B = 0.455, P = 0.003), followed by systolic blood pressure (B = -0.447, P = 0.004), together predicting 31.7% NBW variation. Conclusion: This study highlights that increased maternal postload sugar levels and blood pressure, within the normal range, highly predicts NBW of healthy mothers. These findings may provide focus for early dietary intervention measures to avoid future risks to the mother and baby.
    09/2013; 2013:757459. DOI:10.1155/2013/757459
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