Lisa Hartling, PhD; Donna M. Dryden, PhD; Alyssa Guthrie, MSSc; Melanie Muise, MA; Ben Vandermeer, MSc; Lois Donovan, MD
Disclaimer: The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Tamara Durec (searching), Andrea Milne (searching, technical support), Walie Atkary (screening, data extraction), Dion Pasichnyk (data extraction), Jennifer Seida (screening, project coordination), Teodora Radisic (article retrieval), Jocelyn Shulhan (screening), Annabritt Chisholm (research support, reference management), and Dr. Alun Edwards for providing clinical input throughout the project.
Financial Support: By the AHRQ (contract 290-2007-10021-I).
Potential Conflicts of Interest: Ms. Guthrie: Grant (money to institution); support for travel to meetings for the study or other purposes (money to institution); fees for participation in review activities such as data monitoring boards, statistical analysis, end point committees, and the like (money to institution); payment for writing or reviewing the manuscript (money to institution): AHRQ. Ms. Muise: Grant (money to institution): AHRQ. Mr. Vandermeer: Grant (money to institution): AHRQ. Dr. Donovan: Other: grants from Bridges Grant (International Diabetes Federation and Eli Lilly) outside the submitted work. All other authors have no disclosures. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0190.
Requests for Single Reprints: Lisa Hartling, PhD, ECHA 4-472, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Hartling: ECHA 4-472, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Dr. Dryden: ECHA 4-474, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Ms. Guthrie: Primary Care Division, Alberta Health, 18th Floor, Telus Plaza North Tower, 10025 Jasper Avenue NW, Edmonton, Alberta T5J 1S6, Canada.
Ms. Muise: ECHA 4-492C, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Mr. Vandermeer: ECHA 4-496B, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Dr. Donovan: Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada.
Author Contributions: Conception and design: L. Hartling, D.M. Dryden, L. Donovan.
Analysis and interpretation of the data: L. Hartling, D.M. Dryden, A. Guthrie, M. Muise, B. Vandermeer, L. Donovan.
Drafting of the article: L. Hartling, D.M. Dryden, M. Muise, B. Vandermeer, L. Donovan.
Critical revision of the article for important intellectual content: L. Hartling, D.M. Dryden, M. Muise, B. Vandermeer, L. Donovan.
Final approval of the article: L. Hartling, D.M. Dryden, M. Muise, B. Vandermeer, L. Donovan.
Statistical expertise: B. Vandermeer.
Obtaining of funding: L. Hartling, D.M. Dryden, L. Donovan.
Administrative, technical, or logistic support: L. Hartling, D.M. Dryden, L. Donovan.
Collection and assembly of data: L. Hartling, D.M. Dryden, M. Muise, A. Guthrie, L. Donovan.
Outcomes of treating gestational diabetes mellitus (GDM) are not well-established.
To summarize evidence about the maternal and neonatal benefits and harms of treating GDM.
15 electronic databases from 1995 to May 2012, gray literature, Web sites of relevant organizations, trial registries, and reference lists.
English-language randomized, controlled trials (n = 5) and cohort studies (n = 6) of women without known preexisting diabetes.
One reviewer extracted data, and a second reviewer verified them. Two reviewers independently assessed methodological quality and evaluated strength of evidence for primary outcomes by using a Grading of Recommendations Assessment, Development and Evaluation approach.
All studies compared diet modification, glucose monitoring, and insulin as needed with no treatment. Women who were treated had more prenatal visits than those in control groups. Moderate evidence showed fewer cases of preeclampsia, shoulder dystocia, and macrosomia in the treated group. Evidence was insufficient for maternal weight gain and birth injury. Low evidence showed no difference between groups for neonatal hypoglycemia. Evidence was insufficient for long-term metabolic outcomes among offspring. No difference was found for cesarean delivery (low evidence), induction of labor (insufficient evidence), small-for-gestational-age neonates (moderate evidence), or admission to a neonatal intensive care unit (low evidence).
Evidence is low or insufficient for many outcomes of greatest clinical importance. The strongest evidence supports reductions in intermediate outcomes; however, other factors (for example, maternal weight and gestational weight gain) may impart greater risk than GDM, particularly when glucose levels are modestly elevated.
Treating GDM results in less preeclampsia, shoulder dystocia, and macrosomia; however, current evidence does not show an effect on neonatal hypoglycemia or future poor metabolic outcomes. There is little evidence of short-term harm of treating GDM other than an increased demand for services.
Agency for Healthcare Research and Quality.
Appendix Table 1. MEDLINE Search Strategy
Summary of evidence search and selection.
KQ = key question.
* This systematic review was part of a larger technical report. The search was done to identify relevant studies for all objectives of the full report, which is available at http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1295&pageaction=displayproduct.
Table. Strength of Evidence for Benefits and Harms of Treating GDM
Effect of treatment on outcomes of women with GDM: preeclampsia.
GDM = gestational diabetes mellitus; MH = Mantel–Haenszel; RCT = randomized, controlled trial.
Effect of treatment on outcomes of women with GDM: maternal weight gain.
GDM = gestational diabetes mellitus; IV = inverse variance; RCT = randomized, controlled trial.
Appendix Table 2. Evidence Summary for Benefits and Harms of Treating GDM: Maternal Outcomes
Appendix Table 3. Evidence Summary for Benefits and Harms of Treating GDM: Infant Outcomes
Effect of treatment for shoulder dystocia, neonatal hypoglycemia, and macrosomia (birthweight >4000 g) based on data from randomized, controlled trials.
MH = Mantel–Haenszel.
Effect of treatment on outcomes of women with GDM: admission to the NICU.
GDM = gestational diabetes mellitus; MH = Mantel–Haenszel; NICU = neonatal intensive care unit; RCT = randomized, controlled trial.
Effect of treatment on outcomes of women with GDM who have cesarean delivery.
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Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and Harms of Treating Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med. 2013;159:123-129. doi: 10.7326/0003-4819-159-2-201307160-00661
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Published: Ann Intern Med. 2013;159(2):123-129.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Prevention/Screening.
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