Treating pregnant women for mild gestational diabetes reduces serious birthing problems

September 30, 2009

CHAPEL HILL, N.C. - Treating pregnant women for mild gestational diabetes resulted in fewer cesarean sections and other serious birthing problems associated with larger than average babies, according to a study conducted in part at the University of North Carolina at Chapel Hill.

'This study is important because it clearly indicates the value to mothers and their newborns of screening for and treatment of diabetes-like conditions provoked by pregnancy," said John M. Thorp, M.D., McAllister distinguished professor of obstetrics and gynecology at the UNC School of Medicine and a co-author of the study.

"Our work resolves a 40-year controversy in women's health and should be immediately helpful to both pregnant women and the clinicians caring for them."

The study is published in the Oct. 1 issue of the New England Journal of Medicine. The lead author and principal investigator is Mark B. Landon, M.D. of Ohio State University. It was conducted at 14 sites that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network.

About 4 percent of all pregnant women in the U.S. develop gestational diabetes, resulting in about 135,000 cases each year, Thorp said. Because these women have high blood sugar levels, their babies receive more blood glucose than they need, and the extra energy is stored as fat. These babies tend to be larger and fatter than average at birth and thus are more likely to be affected by problems associated with larger babies, such as the need for cesarean delivery, damage to their shoulders during birth and a greater risk of becoming obese as children and developing type 2 diabetes as adults.

There has been a longstanding controversy among physicians on the question of whether treating pregnant women with gestational diabetes for their high blood sugar levels would provide worthwhile benefits. Several professional organizations advocate screening, but the 2008 guidelines of the U.S. Preventive Services Task Force concluded there is insufficient evidence to support screening for and treatment of gestational diabetes.

Against this background, the MFMU Network launched a clinical trial to determine if treating mothers for mild gestational diabetes would reduce infant deaths and birth-related complications. A total of 958 women between 24 and 31 weeks of pregnancy were randomized, with 485 receiving treatment (including dietary changes, self blood glucose monitoring and insulin if necessary) and 473 in the untreated group.

There were no infant deaths in the study and no significant differences between the two groups in terms of babies born with problems such as hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia and birth trauma.

However, there were significantly fewer babies in the treatment group to experience unusually large size (7.1 percent vs. 14.5 percent), high birth weight (5.9 percent vs. 14.3 percent), shoulder damage during birth (1.5 percent vs. 4.0 percent) or to require cesarean delivery (26.9 percent vs. 33.8 percent).

In addition, Thorp said, "It's especially intriguing that mothers in the treatment arm gained less weight during pregnancy, experienced fewer preterm births and had fewer cases of preeclampsia than mothers in the untreated group." Preeclampsia is a syndrome marked by a sudden increase in the blood pressure of a pregnant woman after the 20th week of pregnancy, which can be fatal or lead to long-term health problems for mother and baby.

The study concludes that "these findings confirm a benefit to the identification and treatment of women with mild carbohydrate intolerance during pregnancy."
-end-


University of North Carolina Health Care

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.