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Although treatment for gestational diabetes mellitus (GDM) is associated with lower rates of perinatal complications, recommendations about management are inconsistent (JW Womens Health May 7 2008). To evaluate further the effects of diabetes treatment on pregnancy outcomes, investigators randomized 958 women with mild GDM to intervention for GDM (dietary counseling, glucose self-monitoring, and insulin as required) or standard prenatal care. Mild GDM was defined as abnormal oral glucose tolerance test results and fasting glucose levels <95 mg/dL.
Frequency of the composite primary outcome (perinatal mortality and neonatal complications associated with maternal hyperglycemia) was similar for both groups. However, treatment for GDM was associated with substantially lower mean birth weights (3302 g vs. 3408 g) and substantially lower risk for large-for-gestational-age infants (7% vs. 14%), cesarean deliveries (27% vs. 34%), and preeclampsia or gestational hypertension (9% vs. 14%).
Landon MB et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009 Oct 1; 361:1339.
Sacks DA. Gestational diabetes — Whom do we treat? N Engl J Med 2009 Oct 1; 361:1396.
Comment
The original diagnostic criteria for GDM — still in use today — are based on the potential for developing adult-onset diabetes; thus, the relation between mild GDM and pregnancy outcomes has never been well defined. Although this study did not show that intervention for GDM lowers risk for perinatal mortality and severe neonatal complications, its results demonstrate that such treatment lowers risk for several secondary outcomes (many of which are related to weight). We still do not know whether the benefits of controlling GDM work against a risk for perinatal complications that rises continuously with glucose levels or that rises sharply beyond a certain threshold glucose level; nonetheless, these results provide compelling evidence in favor of treating women who have mild GDM.