Treating Mild Gestational Diabetes Cuts Risk Of Pre-eclampsia, Delivering Large Infants, Study Finds

Main Category: Pregnancy / Obstetrics
Also Included In: Diabetes;  Hypertension;  Nursing / Midwifery
Article Date: 30 Jan 2009 - 2:00 PDT

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Treating mild gestational diabetes reduces a woman's risk of delivering an excessively large infant and developing pre-eclampsia by 50%, according to a study released Thursday at the meeting of the Society for Maternal Fetal Medicine in San Diego, USA Today reports. The study, funded by the National Institute for Child Health and Human Development and published in Diabetes Care, was led by Ohio State University's College of Medicine obstetrics and gynecology professor Mark Landon. It is the first large-scale U.S. trial to examine whether diagnosing and treating mild gestational diabetes is useful, according to Landon, who added that doctors have long questioned whether mild cases of the condition are worth treating. The study involved 958 pregnant women from 15 medical centers that are part of the Maternal Fetal Medicine Unit Network. About half of the participants received treatment for mild gestational diabetes and the other half did not; 7% of those in the treatment group needed insulin, while the remaining women controlled their blood sugar with diet and exercise.

The study found no difference between the treated and untreated groups with regard to rates of low blood sugar or jaundice, which is common in infants delivered to women whose blood sugar was not well controlled during pregnancy. Six percent of the treated women delivered infants weighing more than 8 pounds, 12 ounces, compared with about 14% of untreated women, and 2.5% of treated women developed pre-eclampsia -- pregnancy-related high blood pressure -- compared with 5.5% of the untreated women. In addition, women in the treated group were 20% less likely than the non-treatment group to have caesarean sections, and their infants were much less likely to have shoulder dystocia, which is when a shoulder gets stuck in the woman's pelvis.

Mary Barton, scientific director of the U.S. Preventive Services Task Force, said that the diagnosis of shoulder dystocia and the decision to perform a c-section are both "highly subjective." The task force in May 2008 examined gestational diabetes screening and treatment, concluding that there is insufficient scientific evidence to advise either for or against screening for gestational diabetes. The task force also noted that a majority of the positive screenings are false positives, which increases a woman's anxiety, but that recommendations for exercise and watching weight gain during pregnancy could be a benefit to all pregnant women. Barton said the task force will review the new study's findings in more detail to determine if it needs to update its recommendations. The American College of Obstetricians and Gynecologists recommends that all pregnant women in the U.S. be screened for gestational diabetes.

According to USA Today, the condition occurs in about 1% of pregnant white women younger than age 25 who are not overweight. The risk is higher for certain groups -- including Native Americans, Hispanics, Asians and blacks -- and for women with previous occurrences of the condition, those older than age 25, and those with a family history of diabetes or obesity. Women who are diagnosed with the condition, which usually goes away after delivery, are more likely to be diagnosed with diabetes later in life when they are not pregnant (Rubin, USA Today, 1/29).

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