Treating gestational diabetes helps mother and
child
Treating a pregnant woman who develops mild gestational diabetes
not only helps her baby, but it also appears to improve her own quality of life
without increasing the risk of Caesarean section, new research finds.
"This study is the most rigorous, best done study on this topic," said Dr. Michael
Greene, director of obstetrics at Massachusetts General Hospital in Boston and the
author of an accompanying editorial in the New England Journal of Medicine. "When
you add the results of this methodologically rigorous large trial to everything
that's gone before it, I think it's hard not to come to the conclusion that it's
time for everybody to be screened and treated."
The findings, which appear in the June 16 issue of the journal, were released early
to coincide with a presentation at the American Diabetes Association's annual meeting
in San Diego.
According to the authors, gestational, or pregnancy-related, diabetes occurs in
2 percent to 9 percent of all pregnancies. Women who develop this condition are
at a higher risk for developing diabetes in later life. In addition, their babies
tend to be larger than average when they are born, which can lead to difficulties
during birth - including injury to the baby, the researchers said.
Despite the risks, it has not been clear whether screening and treatment would help.
Many experts have worried that treatment might increase the risk of Caesarean section,
induce labor and increase anxiety and depression in the mother.
Enter the Australian Carbohydrate Intolerance Study in Pregnant Women, designed
to see if treatment of gestational diabetes would reduce complications during pregnancy
and to see if there were any effects on the mother.
One thousand women who were 24 to 34 weeks pregnant and who had gestational diabetes
were randomly assigned to receive treatment (dietary advice, blood glucose monitoring
and insulin therapy, if needed) or routine care.
Only 1 percent of the women in the treatment group had serious complications versus
4 percent in the routine-care group. This may have reflected the fact that infants
born to mothers in the treatment group had lower birth weights, itself a reflection
of the fact that they tended to be born earlier. There was also a reduction in the
risk of preeclampsia, a condition characterized by potentially life-threatening
elevations in blood pressure.
On the other hand, more infants of women in the treatment group were admitted to
the neonatal nursery (71 percent versus 61 percent). Also, women in the treatment
group were more likely to have induced labor (39 percent versus 29 percent). These
higher rates may have reflected higher levels of vigilance on the part of the physician,
said the study authors.
The rates of Caesarean delivery were almost identical in both groups - 31 percent
and 32 percent.
At three months after birth, women in the treatment group had lower rates of depression
and better quality of life, the researchers add.
Although the trial did not address the issue of screening for gestational diabetes,
"the results indicating that serious perinatal morbidity is reduced by treatment
provides a strong impetus for screening as occurred for most recruited into the
trial," said Dr. Jeffrey Robinson, senior author of the study and the head of the
obstetrics and gynaecology department at Adelaide University."