title: Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research.
abstract: BACKGROUND
  Outcomes of treating gestational diabetes mellitus (GDM) are not well-established.
  
  
  OBJECTIVE
  To summarize evidence about the maternal and neonatal benefits and harms of treating GDM.
  
  
  METHODS
  15 electronic databases from 1995 to May 2012, gray literature, Web sites of relevant organizations, trial registries, and reference lists.
  
  
  METHODS
  English-language randomized, controlled trials (n = 5) and cohort studies (n = 6) of women without known preexisting diabetes.
  
  
  METHODS
  One reviewer extracted data, and a second reviewer verified them. Two reviewers independently assessed methodological quality and evaluated strength of evidence for primary outcomes by using a Grading of Recommendations Assessment, Development and Evaluation approach.
  
  
  RESULTS
  All studies compared diet modification, glucose monitoring, and insulin as needed with no treatment. Women who were treated had more prenatal visits than those in control groups. Moderate evidence showed fewer cases of preeclampsia, shoulder dystocia, and macrosomia in the treated group. Evidence was insufficient for maternal weight gain and birth injury. Low evidence showed no difference between groups for neonatal hypoglycemia. Evidence was insufficient for long-term metabolic outcomes among offspring. No difference was found for cesarean delivery (low evidence), induction of labor (insufficient evidence), small-for-gestational-age neonates (moderate evidence), or admission to a neonatal intensive care unit (low evidence).
  
  
  CONCLUSIONS
  Evidence is low or insufficient for many outcomes of greatest clinical importance. The strongest evidence supports reductions in intermediate outcomes; however, other factors (for example, maternal weight and gestational weight gain) may impart greater risk than GDM, particularly when glucose levels are modestly elevated.
  
  
  CONCLUSIONS
  Treating GDM results in less preeclampsia, shoulder dystocia, and macrosomia; however, current evidence does not show an effect on neonatal hypoglycemia or future poor metabolic outcomes. There is little evidence of short-term harm of treating GDM other than an increased demand for services.
authors.affiliation: Alberta Research Centre for Health Evidence and University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, Canada. hartling@ualberta.ca
authors.forename: Lisa
authors.initials: L
authors.lastname: Hartling
authors.forename: Donna M
authors.initials: DM
authors.lastname: Dryden
authors.forename: Alyssa
authors.initials: A
authors.lastname: Guthrie
authors.forename: Melanie
authors.initials: M
authors.lastname: Muise
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.forename: Lois
authors.initials: L
authors.lastname: Donovan
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D016640:Diabetes, Gestational / Q000097:blood / Q000178:diet therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin