Treat Gestational Diabetes for Baby's Sake
Study Shows Treatment of Diabetes in Pregnant Women Cuts Health Risks for Infants
By
Kathleen Doheny
WebMD Health News
Reviewed By
Louise Chang, MD
Sept. 30, 2009 -- Treating pregnant women who have even mild gestational diabetes helps reduce the risk of complications in infants and the women's own
risk of blood pressure problems, according to a new study.
While gestational diabetes -- defined as having glucose intolerance that
first shows up during a pregnancy -- has long been known to increase the risk
of the woman getting diabetes later in life, the risk of ill effects on the
pregnancy has not been as clear. Those women whose blood sugar levels are very
elevated appear to be at risk of complications, but how the milder form of
gestational diabetes affects the pregnancy has not been known exactly, the
researchers say.
The new study finding "provides the evidence to endorse screening and
treating women even with mild gestational diabetes," says Catherine Spong, MD,
chief of the pregnancy and perinatology branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National
Institutes of Health, and a co-author of the study. It is published in the
New England Journal of Medicine.
Up to 14% of U.S. pregnancies are affected by gestational diabetes,
according to the researchers.
In the study, Spong and colleagues, with lead investigator Mark Landon of
The Ohio State University Medical Center, Columbus, randomly assigned 485
pregnant women with mild gestational diabetes to the treatment group and 473 to
the comparison group. The women were cared for at 15 different medical
centers.
To qualify for the study, women were in the 24th to 31st week of pregnancy
and had a diagnosis of mild gestational diabetes. For the study, researchers
defined mild gestational diabetes as having a fasting glucose level of less
than 95 milligrams per deciliter and having at least two of three timed glucose
measurements taken one hour, two hours, and three hours after drinking a sugary
beverage that exceeded established thresholds.
Gestational diabetes is believed to occur in some women after increased
levels of some hormones that rise during pregnancy hamper the ability of insulin to manage blood sugar. When blood sugar levels rise too much, it can
adversely affect the baby, causing it to grow too big, among other potential
problems.
The comparison group received usual prenatal care; two women in that group
needed insulin to control blood sugar levels.
Women in the treatment group were advised to exercise and received
nutritional counseling, learning how to spread their carbohydrate consumption
throughout the day to better regulate blood sugar levels, Spong tells WebMD.
They then monitored their blood glucose levels at home to be sure the diet
therapy helped keep blood sugar within the desired target range. Of the
treatment group, 93% managed with diet alone, while 7% needed insulin
injections to control their blood sugar.
The researchers then compared the outcomes of the two groups.
Advantages of Treatment of Gestational Diabetes
Women in the treatment group had a number of advantages, the researchers
found. "If treated, they were half as likely to have a large baby," Spong
says. Large babies are at risk for health problems later in life, including
obesity.
Those in the treatment group also were:
- Less likely to need cesarean delivery. While 26.9% of the treatment group
had C-sections, 33.8% of the comparison group did.
- Less likely to deliver babies with shoulder dystocia, in which the shoulder
gets "stuck" during delivery and it becomes an obstetrical emergency. Bigger
babies are at higher risk.
- Less likely to have pregnancy-related high blood pressure and
preeclampsia.
Neither group experienced stillbirths or newborn deaths, another area the
researchers wanted to compare.
Until this study, Spong says, "it hadn't been known if treating those with
mild gestational diabetes improves pregnancy outcome." Now, she says, the study
provides evidence supporting screening and treating women even with mild
gestational diabetes.
"The treatment is pretty straightforward -- it's diet and exercise," she
says. But that's not to say it's simple, she acknowledges, especially if a
woman already has young children to care for. The exact diet and exercise
instructions in the study were left up to the doctors, she says. Typically
advised are carb counting and taking a brisk walk after a meal to help regulate
blood sugar levels, Spong says.
The message for pregnant women from the study is clear, says Eva Pressman,
MD, professor of obstetrics and gynecology and director of the maternal fetal
medicine at the University of Rochester Medical Center, N.Y. "I think the big
message is that glucose control is very important for normal fetal growth," she
says. "Even mild forms of gestational diabetes allow elevated levels of
glucose to get to the fetus, and that creates hormonal changes in the fetus, in
turn leading to excessive growth."
"We know babies who are underweight or overweight have greater risk for
health problems in later life, including diabetes," Pressman says. In her
experience, most pregnant women, if they are found to have gestational
diabetes, are very willing to monitor their diet and make other changes.
"Pregnant women are very motivated health-wise," she says.
SOURCES: Catherine Spong, MD, chief, pregnancy and perinatology branch, Eunice
Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md.
Eva Pressman, MD, professor of obstetrics and gynecology and director of maternal fetal medicine, University of Rochester Medical Center, Rochester, N.Y.
Landon, M. The New England Journal of Medicine, Oct. 1, 2009; vol 361: pp 1339-1348.
WebMD Medical Reference "Understanding Gestational Diabetes -- the Basics."
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