Treating even mild gestational diabetes reduces birth complications

September 30, 2009

A National Institutes of Health network study provided the first conclusive evidence that treating pregnant women who have even the mildest form of gestational diabetes can reduce the risk of common birth complications among infants, as well as blood pressure disorders among mothers.

Treatment of severe gestational diabetes is known to benefit mothers and infants. Although treatment is routinely prescribed for all women with gestational diabetes, before the current study, there was no evidence to show whether treating the mild form of the condition benefited, or posed risks for, mothers or their infants.

The researchers found that, compared to the women's untreated counterparts, women treated for mild gestational diabetes had smaller, leaner babies less likely to be overweight or abnormally large, and less likely to experience shoulder dystocia, an emergency condition in which the baby's shoulder becomes lodged inside the mother's body during birth. Treated mothers were also less likely to undergo cesarean delivery, to develop high blood pressure during pregnancy, or to develop preeclampsia, a life-threatening complication of pregnancy that can lead to maternal seizures and death.

The study was conducted by researchers in the Maternal Fetal Medicine Units Network of the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human (NICHD) and appears in the Oct. 1 New England Journal of Medicine. The study's first author was Mark Landon of Ohio State University.

"Whether to treat mild gestational diabetes has never been entirely clear," said study coauthor Catherine Y. Spong, chief of the Pregnancy and Perinatology Branch at the NICHD. "The study results show conclusively that both mothers and infants do better when gestational diabetes is controlled."

In addition to funding from the NICHD, the study was also supported by the NIH's National Center for Research Resources.

Gestational diabetes occurs when pregnant women who did not have any signs or symptoms of diabetes before they were pregnant develop high blood sugar levels. The condition affects from 1 to 14 percent of all U.S. pregnancies. Gestational diabetes is not well understood, but is thought to occur when hormones produced during pregnancy interfere with the body's ability to use insulin to absorb sugar from the blood.

In most cases, treatment for gestational diabetes consists of lowering blood sugar levels through proper diet and exercise. If diet and exercise alone fail to lower blood sugar levels, women may be treated with drugs that increase the body's ability to use insulin, or may be prescribed insulin itself.

The current study is the first to test whether treatment for mild gestational diabetes is beneficial. The researchers defined mild gestational diabetes as having normal blood sugar levels after fasting but abnormally high levels in at least two readings over the course of three hours after an oral glucose tolerance test, in which women consume a sugary drink. Severe diabetes was defined as high blood sugar levels even after fasting.

To conduct the study, the researchers enrolled 958 women with mild gestational diabetes. Roughly half were treated for their diabetes and half were not, receiving only standard pregnancy care.

In their statistical analysis of the study results, the researchers combined several serious potential outcomes into one figure, to represent a single and primary outcome. The primary outcome consisted of all cases of newborn death, stillbirth, newborns with low blood sugar or with high insulin levels, birth-related injuries, and high bilirubin levels (an indicator of newborn jaundice). In terms of the primary outcome, there were no differences between the two groups of women. But the women who received treatment fared significantly better than the untreated women on other measures.

Specifically, compared to women who did not receive treatment, those who did were:"Obstetricians are concerned with the immediate risks of birth trauma which may accompany delivery of large infants to women with diabetes," Dr. Landon said.

These risks include fracture of the skull and collar bones, and injury to the nerves that connect the arm, hand and shoulder to the spine.

"Our study demonstrates that treating even mild diabetes can reduce fetal overgrowth and thus could also reduce these birth related risks."

Previous studies suggest that the higher birthweights and greater proportion of body fat seen in the newborns of women with gestational diabetes also pose increased health risks for these children later in life, Dr. Spong said. The children are more likely than other children to be overweight and, as adults, more likely to have impaired glucose tolerance, a prediabetic condition.

"The children would need to be followed long term to be certain, but it's possible that treating women with mild gestational diabetes to reduce birthweight and body fat among their newborns may benefit these children later in life," Dr. Spong said.
-end-
The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute's Web site at http://www.nichd.nih.gov/.

The National Institutes of Health (NIH) -- The Nation's Medical Research Agency -- includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.