Gestational diabetes: The consequence of not treating

University of Texas at San Antonio, San Antonio, Texas, United States
American Journal of Obstetrics and Gynecology (Impact Factor: 4.7). 05/2005; 192(4):989-97. DOI: 10.1016/j.ajog.2004.11.039
Source: PubMed


Untreated gestational diabetes mellitus carries significant risks of perinatal morbidity at all severity levels; treatment will enhance outcome.
A matched control of 555 gravidas, gestational diabetes mellitus diagnosed after 37 weeks, were compared with 1110 subjects treated for gestational diabetes mellitus and 1110 nondiabetic subjects matched from the same delivery year for obesity, parity, ethnicity, and gestational age at delivery. The nondiabetic subjects and those not treated for gestational diabetes mellitus were matched for prenatal visits.
A composite adverse outcome was 59% for untreated, 18% for treated, and 11% for nondiabetic subjects. A 2- to 4-fold increase in metabolic complications and macrosomia/large for gestational age was found in the untreated group with no difference between nondiabetic and treated subjects. Comparison of maternal size, parity, and disease severity revealed a 2- to 3-fold higher morbidity rate for the untreated groups, compared with the other groups.
Untreated gestational diabetes mellitus carries significant risks for perinatal morbidity in all disease severity levels. Timely and effective treatment may substantially improve outcome.

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    • "compared with 1110 subjects treated for GDM and 1110 nondiabetic subjects, the composite adverse outcome was 59% for untreated, 18% for treated, and 11% for nondiabetic subjects. Moreover, a two-to fourfold increase in metabolic complications and macrosomia/large for gestational age was found in the untreated group with no difference between the nondiabetic and treated subjects [1]. Crowther et al. [2] randomly assigned 1000 women between 24 and 34 weeks of gestation who had GDM to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care. "
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    ABSTRACT: Gestational diabetes mellitus (GDM) complicates 3-15% of pregnancies depending upon geographic location and ethnic groups, and its incidence is estimated to increase even further due to the increasing rates of obesity in the general population and the trend towards advanced maternal age in pregnancy. GDM is associated with adverse pregnancy outcome such as increased rate of fetal macrosomia, neonatal metabolic disturbances and maternal injuries. It was shown that there is an inverse relation between maternal glycemic control and the risk for complications. When diet and exercise therapy fail in achieving good glycemic control pharmacological intervention is warranted. This chapter will deal with the evidence regarding the various pharmacological intervention for glycemic control in women with GDM, when to start and what pharmacological agent to use.
    Bailli&egrave re s Best Practice and Research in Clinical Obstetrics and Gynaecology 08/2014; 29(2). DOI:10.1016/j.bpobgyn.2014.04.020 · 1.92 Impact Factor
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    • "It increases the incidence of macrosomia and large for gestational age (LGA) babies which in turn increases the risk for shoulder dystocia, birth trauma and caesarean section [2]–[5]. Besides, the risks for perinatal mortality, neonatal hypoglycemia, hyperbilirubinemia, gestational hypertension and pre-eclampsia also increase in GDM patients [2], [4], [6]. Chances for development of type 2 diabetes mellitus are also reported to increase in both mother and infant later in their life [6]–[8]. "
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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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    • "Later in life, both the mother and child are at increased risk of hospital admission, obesity, type 2 diabetes and heart disease [2,4-7]. Fortunately, these complications seem to be lessened by better detection and management of the condition [8,9]. "
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    ABSTRACT: The risks associated with gestational diabetes mellitus (GDM) are well recognized, and there is increasing evidence to support treatment of the condition. However, clear guidance on the ideal approach to screening for GDM is lacking. Professional groups continue to debate whether selective screening (based on risk factors) or universal screening is the most appropriate approach. Additionally, there is ongoing debate about what levels of glucose abnormalities during pregnancy respond best to treatment and which maternal and neonatal outcomes benefit most from treatment. Furthermore, the implications of possible screening options on health care costs are not well established. In response to this uncertainty there have been repeated calls for well-designed, randomised trials to determine the efficacy of screening, diagnosis, and management plans for GDM. We describe a randomised controlled trial to investigate screening uptake rates and the clinical and cost effectiveness of screening in primary versus secondary care settings. The objective of this study is to assess screening uptake rates, and the clinical and cost effectiveness of screening for GDM in primary versus secondary care. This is will be an unblinded, two-group, parallel randomised controlled trial (RCT). The target population includes 784 women presenting for their first antenatal visit at 12 to 18 weeks gestation at two hospitals in the west of Ireland: Galway University Hospital and Mayo General Hospital. Participants will be offered universal screening for GDM at 24 to 28 weeks gestation in either primary care (n = 392) or secondary care (n = 392) locations. The primary outcome variable is the uptake rate of screening. Secondary outcomes include indicators of clinical effectiveness of screening at each screening site (primary and secondary) including gestational week at time of screening, time to access antenatal diabetes services for women diagnosed with GDM, and pregnancy and neonatal outcomes for women with GDM. In addition, parallel economic and qualitative evaluations will be conducted. The trial will cover the period from the woman's first hospital antenatal visit at 12 to 18 weeks gestation, until the completion of the pregnancy.Trial registration: Current Controlled Trials: ISRCTN02232125.
    Trials 01/2014; 15(1):27. DOI:10.1186/1745-6215-15-27 · 1.73 Impact Factor
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