Debra A. Guinn, MD
Does treatment for gestational diabetes mellitus (GDM) reduce perinatal or maternal complications?
Included studies compared treatment with usual care, or intensified treatment with less intensified treatment, in pregnant women with impaired glucose tolerance and reported on ≥ 1 outcome of interest. Outcomes included maternal mortality, preeclampsia, shoulder dystocia, method of delivery, perinatal and neonatal mortality, birth trauma, neonatal hypoglycemia treated with glucose infusion, and admission to neonatal intensive care.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Library, and several other databases (Oct 2009) and reference lists were searched for randomized controlled trials (RCTs). 18 RCTs (mean age 26 to 33 y; mean gestational age 26 to 32 wk at study entry) met the selection criteria after 1 eligible study was excluded because of discrepancies between publications. 5 studies (n = 2999) compared diet or diet with insulin with usual care. 13 studies (n = 1934) compared higher and lower intensities of treatment, including diet, insulin, monitoring, and counseling, alone or in combination.
Treatment vs usual care: Meta-analysis showed that treatment for GDM reduced risk for shoulder dystocia more than usual care; groups did not differ for caesarean section, birth trauma, or neonatal intensive care (Table). No studies reported maternal mortality. Data for preeclampsia, perinatal and neonatal mortality, and neonatal hypoglycemia were not pooled because of insufficient data or heterogeneity between studies. More intense vs less intense treatment: More intense treatment decreased risk for shoulder dystocia more than less intense treatment; groups did not differ for caesarean section, perinatal and neonatal mortality, or birth trauma (Table). There were no reports of maternal mortality or neonatal hypoglycemia. Data for preeclampsia and admission to neonatal intensive care were not pooled because of insufficient data or heterogeneity between studies.
Treatment for gestational diabetes reduces risk for shoulder dystocia but not other patient-relevant perinatal or maternal outcomes.
Treatment vs usual care and higher vs lower intensity treatment for gestational diabetes mellitus*
*Abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from control event rates and odds ratios in article.
Guinn DA. Review: Treatment for gestational diabetes reduces risk for shoulder dystocia. Ann Intern Med. ;153:JC3–6. doi: 10.7326/0003-4819-153-6-201009210-02006
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Published: Ann Intern Med. 2010;153(6):JC3-6.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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