Treatment With Diet and Exercise for Women With Gestational Diabetes Mellitus Diagnosed Using IADPSG Criteria.
BACKGROUND
Prevalence of gestational diabetes mellitus (GDM) and obesity continue to increase.


OBJECTIVE
This study aimed to ascertain whether diet and exercise is a successful intervention for women with GDM and whether a subset of these women have comparable outcomes to those with normal glucose tolerance (NGT).


METHODS
This was a retrospective cohort study of five antenatal centers along the Irish Atlantic seaboard of 567 women diagnosed with GDM and 2499 women with NGT during pregnancy.


METHODS
Diet and exercise therapy on diagnosis of GDM were prescribed and multiple maternal and neonatal outcomes were examined.


RESULTS
Infants of women with GDM were more likely to be hypoglycemic (adjusted odds ratio [aOR], 7.25; 95% confidence interval [CI], 2.94-17.9) at birth. They were more likely to be admitted to the neonatal intensive care unit (aOR, 2.16; 95% CI, 1.60-2.91). Macrosomia and large-for-gestational-age rates were lower in the GDM group (aOR, 0.48; 95% CI, 0.37-0.64 and aOR, 0.61; 95% CI, 0.46-0.82, respectively). There was no increase in small for gestational age among offspring of women with GDM (aOR, 0.81; 95% CI, 0.49-1.34). Women with diet-treated GDM and body mass index (BMI) < 25 kg/m(2) had similar outcomes to those with NGT of the same BMI group. Obesity increased risk for poor pregnancy outcomes regardless of diabetes status.


CONCLUSIONS
Medical nutritional therapy and exercise for women with GDM may be successful in lowering rates of large for gestational age and macrosomia without increasing small-for-gestational-age rates. Women with GDM and a BMI less than 25 kg/m(2) had outcomes similar to those with NGT suggesting that these women could potentially be treated in a less resource intensive setting.
Galway Diabetes Research Centre (O.K., A.M.E., L.C., B.K., F.P.D.), Galway University Hospital, Galway, Ireland; HRB Clinical Research Facility (P.G.), Galway, Ireland; and National University of Ireland (F.P.D.), Galway, Ireland.
Oratile
O
Kgosidialwa
Galway Diabetes Research Centre (O.K., A.M.E., L.C., B.K., F.P.D.), Galway University Hospital, Galway, Ireland; HRB Clinical Research Facility (P.G.), Galway, Ireland; and National University of Ireland (F.P.D.), Galway, Ireland.
Aoife M
AM
Egan
Galway Diabetes Research Centre (O.K., A.M.E., L.C., B.K., F.P.D.), Galway University Hospital, Galway, Ireland; HRB Clinical Research Facility (P.G.), Galway, Ireland; and National University of Ireland (F.P.D.), Galway, Ireland.
Louise
L
Carmody
Galway Diabetes Research Centre (O.K., A.M.E., L.C., B.K., F.P.D.), Galway University Hospital, Galway, Ireland; HRB Clinical Research Facility (P.G.), Galway, Ireland; and National University of Ireland (F.P.D.), Galway, Ireland.
Breda
B
Kirwan
Galway Diabetes Research Centre (O.K., A.M.E., L.C., B.K., F.P.D.), Galway University Hospital, Galway, Ireland; HRB Clinical Research Facility (P.G.), Galway, Ireland; and National University of Ireland (F.P.D.), Galway, Ireland.
Patricia
P
Gunning
Galway Diabetes Research Centre (O.K., A.M.E., L.C., B.K., F.P.D.), Galway University Hospital, Galway, Ireland; HRB Clinical Research Facility (P.G.), Galway, Ireland; and National University of Ireland (F.P.D.), Galway, Ireland.
Fidelma P
FP
Dunne
D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000178:diet therapy* / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology / Q000517:prevention & control; D018149:Glucose Intolerance; D006801:Humans; D007003:Hypoglycemia / Q000151:congenital / Q000209:etiology; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016896:Treatment Outcome