Treating diabetes in pregnancy curbs complications

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Treating women who develop Diabetes in pregnancy (Gestational diabetes) reduces the rate of serious complications without increasing the rate of cesarean delivery, according to new study findings.

Although the risks related to Gestational diabetes are well known, it has been unclear if screening and treatment to lower maternal blood sugar levels can reduce these risks, Dr. Caroline A. Crowther and her associates comment in their report, published in The New England Journal of Medicine.

The Journal released the article early to coincide with the authors’ presentation at the American Diabetes Association meeting in San Diego.

To evaluate the effects of treating Gestational diabetes, Crowther, with the University of Adelaide in Australia, and her associates studied women with signs of gestational diabetes between 24 and 34 weeks into pregnancy.

By random draw, a total of 490 women were assigned to intensive treatment, including dietary advice, blood sugar monitoring, and insulin therapy, the authors note. Another 510 patients were assigned to routine care.

Serious complications among the infants - death, shoulder impeding delivery, bone fracture, and nerve palsy - were significantly more frequent in the routine-care group (4 percent versus 1 percent) after accounting for factors such as maternal age, race or ethnic group, and number of previous pregnancies.

A higher percentage of infants in the intervention group were admitted to the neonatal nursery (71 percent versus 61 percent), and women in the intervention group were more likely to undergo labor induction (39 percent versus 29 percent), both of which the investigators attribute to the treating physicians’ knowledge of their gestational diabetes.

The rates of cesarean section were similar in the two groups.

At three months after delivery, women in the intervention group had lower rates of depression and higher scores on quality of life scales.

The report “provides some long-awaited evidence to support the use of screening and treatment for women at risk,” Drs. Michael F. Greene and Caren G. Solomon, from Massachusetts General Hospital in Boston, write in an accompanying editorial.

SOURCE: The New England Journal of Medicine, June 16, 2005.

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