A randomized trial evaluating a predominantly fetal growth-based strategy to guide management of gestational diabetes in Caucasian women.
ABSTRACT 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.
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ABSTRACT: The prevalence of gestational diabetes mellitus has been shown to vary between ethnic groups. The differences in the clinical characteristics and outcomes of women with gestational diabetes mellitus from various ethnic groups have not been clearly defined. A retrospective review of women with gestational diabetes mellitus from a single institution between 2007 and 2010 was conducted. The clinical profiles of women from five ethnic groups (South-East Asian, South Asian, Middle Eastern, Anglo-European and Pacific Islander) were documented, including the outcomes of their pregnancy. In this cohort of 827 women from these five ethnic groups, South-East Asians had the lowest BMI, lowest fasting (yet highest 2-h) glucose level on 75-g glucose tolerance test, lowest need for insulin therapy and lowest rate of macrosomia. South Asians had the lowest parity but strongest family history of diabetes. Their offspring also had the lowest birthweight. Women from Pacific Islands had the highest parity, BMI, fasting glucose levels on 75-g glucose tolerance test, HbA(1c) (at diagnosis of gestational diabetes mellitus as well as at 36 weeks' gestation) and greatest need for insulin therapy. Their offspring also had the highest birthweights. This study highlighted the significant differences in clinical characteristics of women with gestational diabetes mellitus among five ethnic groups. These differences may need to be considered in the management of gestational diabetes mellitus, especially in the interpretation of normality for pregnancy.Diabetic Medicine 09/2011; 29(3):366-71. · 3.24 Impact Factor
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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
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ABSTRACT: To perform a systematic review and meta-analysis of randomized controlled trials assessing ultrasound-guided versus conventional management in women with a broad severity-spectrum of gestational diabetes mellitus. Systematic review and meta-analysis of trials published until August 2012. PubMed and Web of Science databases. Eighteen studies were reviewed in full text. Eligibility criteria were (i) randomized controlled trials comparing metabolic management in women with gestational diabetes mellitus and ultrasound-based vs. the conventional management to assess fetal growth, (ii) representative of the whole spectrum of hyperglycemia and fetal growth, (iii) data on perinatal outcomes. Review Manager 5.0 was used to summarize the results. Two studies fulfilled inclusion criteria. The ultrasound-guided group had a lower rate of large-for-gestational age newborns (relative risk 0.58, 95% confidence interval 0.34-0.99), macrosomia (relative risk 0.32, 95% confidence interval 0.11-0.95) and abnormal birthweight (small/large-for-gestational age, relative risk 0.64, 95% confidence interval 0.45-0.93) and a higher rate of insulin treatment (relative risk 1.58, 95% confidence interval 1.14-2.20). The number of women with gestational diabetes with a need to treat to prevent an additional newborn with abnormal birthweight was 10. In women with a broad severity-spectrum of gestational diabetes mellitus, ultrasound-guided management improves birthweight distribution, but increases the need for insulin treatment. More research is needed in this area because results are derived from a limited number of patients.Acta Obstetricia Et Gynecologica Scandinavica 10/2013; · 1.85 Impact Factor