Treating Mild Diabetes in Pregnancy Carries Significant Benefit

New research demonstrates the importance of treating pregnant women with even the mildest forms of gestational diabetes to reduce healthcare risks for both infants and mothers.

Dr. Mark Landon, lead investigator of the multicenter study, and a team of investigators from the Eunice Kennedy Shriver National Institute of Child Health and Human Development conducted a clinical trial to determine if a benefit existed to diet intervention and frequent glucose monitoring in the management of mild gestational diabetes.

The results appear in the Oct. 1, 2009 issue of The New England Journal of Medicine.

“Treatment is prescribed on a regular basis for most women with gestational diabetes. But we have lacked the evidence until now as to whether treatment of the mildest cases would benefit, or pose risks for, mothers or their newborns,” says Landon, who is also interim chair of obstetrics and gynecology at The Ohio State University Medical Center. “The study confirms that it is worth the time and effort to treat women with even the mildest form of glucose intolerance during pregnancy.”

In most cases of gestational diabetes, a woman receives her diagnosis during pregnancy, and the diabetes does not persist after pregnancy. However, these women have a higher chance of being diagnosed again with adult onset diabetes later in life.

This randomized study included 958 women at 15 medical centers, half receiving treatment for their mild gestational diabetes, and half receiving the usual prenatal care.

Women who received treatment in the study were half as likely to deliver babies with excess body fat and were half as likely to experience shoulder dystocia at birth, occurring when a baby’s shoulders are caught in the maternal pelvis after delivery of the infant’s head. The women with treatment also had fewer cesarean deliveries and less preeclampsia, or hypertensive disorders of pregnancy.

The treatment involved a diet plan, together with close monitoring using a portable meter. If a woman in the study received treatment, she performed at least four glucose tests per day, during her fasting and after meals, to be certain that the diet therapy was keeping her blood glucose within the desired target range. Of the women treated, 93 percent were managed with diet intervention alone, whereas only 7 percent required insulin injections to control blood sugar.

If a woman has elevated blood sugar levels during pregnancy, the fetus may also experience high blood sugar levels. As a result, the fetus makes extra insulin, which can lead to excess body fat. Previous studies have suggested that larger babies have an increased frequency of long-term complications such as childhood diabetes and a risk for type II diabetes throughout their lifetime, according to Landon.

“The condition of gestational diabetes may affect up to 14 percent of all U.S. pregnancies,” says Landon. “Recent studies have indicated that the frequency of gestational diabetes is, in fact, increasing in the United States and worldwide. Because of the increasing frequency of gestational diabetes, our study importantly gives hope to affected women that the condition is generally manageable, with dietetic modifications and close monitoring during pregnancy. Considering the potential downstream effects on the infants, treatment at this stage might serve to control the amount of diabetes in the future.”

The study was sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network – a part of the National Institutes of Health – in addition to the NIH’s National Center for Research Resources.

Source

Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JM Jr, Sciscione A, Catalano P, Harper M, Saade G, Lain KY, Sorokin Y, Peaceman AM, Tolosa JE, Anderson GB; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009 Oct 1;361(14):1339-48. PMID: 19797280

Ohio State University Medical Center Released: 10/2/2009

Key concepts: gestational diabetes, pregnancy, blood sugar levels, insulin