Gestational Diabetes: Controversies About Diagnosis and Treatment Persist

Gestational diabetes mellitus generally is defined as glucose intolerance that is first identified during pregnancy. But what constitutes glucose intolerance during pregnancy, and how should it be treated? In two randomized trials, researchers address aspects of these questions.

In the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, conducted in nine countries, investigators assessed pregnancy outcomes in more than 23,000 women who had 75-g oral glucose-tolerance test levels ≤105 mg/dL fasting and ≤200 mg/dL after 2 hours between 24 and 32 weeks of gestation. Birth weights, umbilical cord–blood C-peptide levels (a surrogate for fetal insulin), and rates of cesarean delivery and neonatal hypoglycemia increased directly and continuou…