To improve the health of both mother and baby, even mild gestational diabetes should be treated, researchers say — helping resolve a long-standing dilemma in obstetrics.
Rates of gestational diabetes have been increasing as more U.S. women enter pregnancy overweight. Moderate to severe cases of the condition have long been treated, but doctors have been uncertain whether women with mild increases in blood-sugar levels warrant additional care.
“Health care providers do not wish to over-treat women or unnecessarily alarm them, nor do they wish to impose extra costs, including self-glucose monitoring,” said Dr. Mark Landon, lead investigator and interim chairman of obstetrics and gynecology at Ohio State University Medical Center.
But it seems action does need to be taken.
In a federally funded study, published in today’s New England Journal of Medicine, researchers assigned 958 women with mild gestational diabetes — all of whom were between 24 and 31 weeks’ pregnant — to receive either diabetes treatment or no treatment. The treatment group was counseled on diet and how to monitor blood glucose and, in some cases, prescribed insulin.
Most of the babies in both arms of the study were born at normal weights. However, in the treatment group, 7.1 percent of the infants were too large — defined as at or above the 90th percentile — compared with 14.5 percent in the untreated group. Babies in the treated group also were less likely to be born via cesarean section or to suffer trauma at birth.
The treated group gained less weight during pregnancy and had fewer preterm births and fewer cases of preeclampsia, a dangerous increase in blood pressure. The study was conducted at 14 sites nationwide and was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
When women develop gestational diabetes, their fetuses receive more blood sugar than they need. The extra energy is stored as fat, so the babies tend to be fatter at birth. Not only does the extra weight create more problems at the time of delivery, but such babies appear to have an increased risk of developing obesity and metabolic diseases.
