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Study Urges Treatment for Even Mild Gestational Diabetes
Reported October 02, 2009
WEDNESDAY, Sept. 30 (HealthDay News) -- Pregnant women who receive
treatment for the mildest forms of gestational diabetes -- including diet
and exercise intervention, self-monitoring of blood glucose levels and
possibly insulin therapy -- are less likely to have serious birth
complications or develop preeclampsia or high blood pressure during
pregnancy, according to new research.
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It's been unclear whether treating borderline cases of gestational diabetes
would make a difference in pregnancy outcomes. But the study's lead author,
Dr. Mark Landon, professor and interim chair of obstetrics and gynecology at
Ohio State University Medical Center, said that the finding "demonstrates
that there's a significant clinical benefit to treating even the mildest
form of gestational diabetes."
Results of the study are published in the Oct. 1 issue of the New England
Journal of Medicine.
"Now, we have two randomized, controlled trials, and both showed decreases
in big babies, preeclampsia and maternal weight gain," said Dr. David Sacks,
a maternal-fetal medicine specialist at Kaiser Foundation Hospital in
Bellflower, Calif., and the author of an accompanying editorial in the same
issue of the journal. The second study he referred to was done in Australia
and published in 2005.
Gestational diabetes is a transient form of diabetes that occurs during
pregnancy. However, women who've had gestational diabetes have been shown to
have a higher risk for developing type 2 diabetes later in life. Depending
on the criteria used to define gestational diabetes, the condition occurs in
between 1 percent and 14 percent of all pregnancies, according to Landon's
study.
"The frequency of gestational diabetes is increasing worldwide, and while
most obstetricians screen for this condition, some have remained skeptical
about treating mild gestational diabetes, and are not as aggressive in
treating milder forms with dietary intervention and self-blood glucose
monitoring," Landon explained.
To get a better idea of whether treating women with mild forms of
gestational diabetes could make a difference, he and his colleagues
recruited 958 pregnant women who were classified as having mild gestational
diabetes.
A treatment group of 485 of the women were given counseling on diet and
exercise, taught how to monitor their own blood sugar levels and given
insulin when necessary. The other 473, considered the control group,
received standard pregnancy care. Only 7 percent of the women in the
treatment group required insulin, Landon said.
The study found that the frequency of babies born too-large for their
gestational age was reduced by more than half -- 14.5 percent of the control
group versus 7.1 percent of the treatment group had big babies. The
pregnancy complication known as shoulder dystocia, which means that the
shoulders have gotten so large they're difficult to deliver, was found to be
4 percent in the control group and 1.5 percent in treated group.
Cesarean delivery rates also were lower for women who received treatment for
their gestational diabetes -- 26.9 percent compared with 33.8 percent of the
control group. Women who received treatment also had lower rates of
preeclampsia and high blood pressure -- 8.6 percent versus 13.6 percent in
the control group, the study found.
Landon said that the reduction of many of the birth complications resulted
from the mother's blood sugar being under control, which doesn't cause
overnourishment of the baby and thus the baby's size stays closer to normal.
Neither Landon nor Sacks could explain the reduction in preeclampsia and
high blood pressure. Sacks theorized that because both diabetes and high
blood pressure are inflammatory processes, what helps reduce one might also
help the other. But, he added, no one really knows right now.
What is clear, said Dr. Miriam Greene, an obstetrician and gynecologist at
NYU Langone Medical Center, is that "when women with mild gestational
diabetes are treated well, there's a decreased incidence of birth trauma."
Greene said that she's already been treating women with the mildest forms of
gestational diabetes, and that it does make a difference.
Sue McLaughlin, president of health care and education for the American
Diabetes Association, said that the study provides "another example of how
preventive health care pays off in positive health outcomes and may save
lives, dollars in the health-care system and improve the quality of life in
future years for these families."
According to McLaughlin, "Physicians need to take a proactive role in
educating women of childbearing age about their risk for this condition so
that women can implement healthy lifestyle behaviors, which promote weight
control and prevention of excessive weight gain in this and future
pregnancies."
Source : USNews.com |
