A Randomized Trial Evaluating a Predominately Fetal Growth–Based Strategy to Guide Management of Gestational Diabetes in Caucasian Women

Humboldt-Universität zu Berlin, Berlín, Berlin, Germany
Diabetes Care (Impact Factor: 8.42). 02/2004; 27(2):297-302. DOI: 10.2337/diacare.27.2.297
Source: PubMed


To compare the management of Caucasian women with gestational diabetes (GDM) based predominantly on monthly fetal growth ultrasound examinations with an approach based solely on maternal glycemia.
Women with GDM who attained fasting capillary glucose (FCG) <120 mg/dl and 2-h postprandial capillary glucose (2h-CG) <200 mg/dl after 1 week of diet were randomized to management based on maternal glycemia alone (standard) or glycemia plus ultrasound. In the standard group, insulin was initiated if FCG was repeatedly >90 mg/dl or 2h-CG was >120 mg/dl. In the ultrasound group, thresholds were 120 and 200 mg/dl, respectively, or a fetal abdominal circumference >75th percentile (AC>p75). Outcome criteria were rates of C-section, small-for-gestational-age (SGA) or large-for-gestational-age (LGA) infants, neonatal hypoglycemia (<40 mg/dl), and neonatal care admission.
Maternal characteristics and fetal AC>p75 (36.0 vs. 38.4%) at entry did not differ between the standard (n = 100) and ultrasound groups (n = 99). Assignment to (30.0 vs. 40.4%) and mean duration of insulin treatment (8.3 vs. 8.1 weeks) did not differ between groups. In the ultrasound group, AC>p75 was the sole indication for insulin. The ultrasound-based strategy, as compared with the maternal glycemia-only strategy, resulted in a different treatment assignment in 34% of women. Rates of C-section (19.0 vs. 18.2%), LGA (10.0 vs. 12.1%), SGA (13.0 vs. 12.1%), hypoglycemia (16.0 vs. 17.0%), and admission (15.0 vs. 14.1%) did not differ significantly.
GDM management based on fetal growth combined with high glycemic criteria provides outcomes equivalent to management based on strict glycemic criteria alone. Inclusion of fetal growth might provide the opportunity to reduce glucose testing in low-risk pregnancies.

15 Reads
  • Source
    • "Clinical recognition of GDM is important because it may lead to appropriate perinatal management. Results from a randomized controlled trial show that treatment of GDM by means of dietary advice, blood glucose monitoring, and insulin therapy, if required, reduces the rate of serious perinatal complications (3, 4) and promote postpartum diabetes-prevention strategies (5-9). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Gestational diabetes mellitus (GDM) is common problem during pregnancy. Diagnostic criteria of this problem are based on foreign population. Because of differences in racial, cultural, and nutritional characteristics, we need to determine these criteria are suitable for Iranian population. Objective: To determine whether different diagnostic criteria of gestational diabetes mellitus (GDM) are suitable for Iranian population. Materials and Methods: Prospective study was performed on 617 pregnant women. 1804 subjects referred for 50 g glucose challenge test (GCT) between 24th and 28th weeks of gestation. 617 women with abnormal GCT (blood glucose ≥130 mg/dl) underwent 100-g 3-h oral glucose tolerance test (OGTT). The results were classified by three diagnostic criteria: new “Iranian” diagnostic criteria based on the results from the 100-g 3-h OGTT performed in healthy participating women; the Carpenter and Coustan (CC) criteria; and the National Diabetes Data Group (NDDG) criteria. Obstetric and neonatal outcomes were recorded. Results: With 89% as the statistical cutoff value for the 100-g 3-h OGTT, the new diagnostic criteria were 92, 179, 153, and 121 mg/dL at 0, 60, 120, and 180 min. The K value was 0.945 for the new criteria vs. the CC criteria and 0.657 for the new criteria vs. the NDDG criteria (p<0.001). In women with GDM, the incidence rates of adverse outcomes by the new and CC criteria were similar, but higher than NDDG criteria (p<0.05). Conclusion: Carpenter and Coustan criteria are applicable to Iranian pregnant women for diagnosis of GDM.
    Iranian Journal of Reproductive Medicine 05/2012; 10(3-Vol. 10. No. 3. pp:, May 2012):237-242. · 0.19 Impact Factor
  • Source
    • "Severe hypoglycaemia during pregnancy in women with type 1 diabetes is common and planning of pregnancy does not decrease the risk. Even a trial demonstrating the possibility to base management of gestational diabetes predominantly on ultrasound examinations included SMBG with six daily measurements if insulin treatment was started [30]. In summary, there is only limited evidence from RCTS in favour of SMBG for improving pregnancy outcomes in type 1 or gestational diabetes. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Self-monitoring of blood glucose (SMBG) has been considered one major breakthrough in diabetes therapy because, for the first time, patients were able to determine their blood glucose levels during daily life. It seems obvious that this must be of advantage to disease management and clinical outcome, but it has become a nightmare for those trying to provide evidence. Randomised controlled trials have yielded inconsistent results on a benefit of SMBG-based treatment strategies not only in type 2 but - surprisingly - also in type 1 and gestational diabetes. Despite this, SMBG is being considered indispensible in intensive insulin treatment, but is being debated for other clinical settings. When considering the non-RCT based reasons for recommending SMBG in type 1 and gestational diabetes it becomes apparent that the same reasons also apply to type 2 diabetes.
    Diabetes research and clinical practice 11/2009; 87(2):150-6. DOI:10.1016/j.diabres.2009.10.014 · 2.54 Impact Factor

Show more


15 Reads