Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.
BACKGROUND
We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications.


METHODS
We randomly assigned women between 24 and 34 weeks' gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care. Primary outcomes included serious perinatal complications (defined as death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, induction of labor, cesarean birth, and maternal anxiety, depression, and health status.


RESULTS
The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P<0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women's mood and quality of life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group.


CONCLUSIONS
Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman's health-related quality of life.
Crowther
Caroline A
CA
Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia.
Hiller
Janet E
JE
Moss
John R
JR
McPhee
Andrew J
AJ
Jeffries
William S
WS
Robinson
Jeffrey S
JS
D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000032:analysis; D002585:Cesarean Section / Q000706:statistics & numerical data; D019052:Depression, Postpartum / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000150:complications / Q000178:diet therapy / Q000628:therapy*; D004420:Dystocia / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology / Q000209:etiology; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D005951:Glucose Tolerance Test; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007226:Infant Mortality; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use*; D007751:Labor, Induced / Q000706:statistics & numerical data; D010243:Paralysis / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy / Q000097:blood; D011256:Pregnancy Outcome / Q000453:epidemiology*
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin