Control
of Gestational Diabetes Has Little Effect on Birth
Weight
Prompt diagnosis of gestational diabetes mellitus
appears to have no bearing on whether the fetus
is large or small for its gestational age.
"We
found no correlation between extremes of birth
weight and pre-pregnancy weight, weight gain during
pregnancy, or whether the mothers required insulin
to control their diabetes," said Florence
Amorado-Santos, MD, an endocrinology fellow, University
of Santo Tomas Hospital, Manila, Philippines.
Dr.
Amorado-Santos presented these findings on May
15th at the (AACE: ) American Association of Clinical
Endocrinologists 12th Annual Meeting and Clinical
Congress.She collaborated with Ma Honolina Sero-Gomez,
MD, assistant professor of endocrinology, University
of Santo Tomas Hospital.
The
investigators set out to determine the role of
diabetes management on maternal and fetal outcomes
in women with gestational diabetes mellitus. Dr.
Amorado-Santos noted that the women were managed
with a modified protocol based on the Asian Federation
of Endocrine Societies (ASEAN) Study Group on
Diabetes in Pregnancy (ASGODIP), which was developed
as a standard of care for gestational diabetes.
"We
modified the ASGODIP protocol, [using] either
the 75 g or 100 g glucose-tolerance test, while
the original protocol only used the 75 g test,"
Dr. Amorado-Santos explained. The protocol used
in the study defined the threshold of diabetes
at a fasting blood glucose of over 100 mg/dL as
hyperglycemic, and 1hour postprandial glucose
exceeding 130 mg/dL.
Of
165 diagnosed patients, the investigators evaluated
the data on 53 women. The women were initially
monitored with a maternal diabetes profile, including
pregestational body mass index (BMI), total pregnancy
weight gain, family history of diabetes, and previous
history of gestational diabetes. The participants
used insulin therapy if dietary management was
inadequate to control blood glucose. The investigators
followed the women until their infants were delivered.
The
women had a pregestational mean BMI of 23.7 kg/m2,
and gained an average of 13.3 kg. Among 70% of
the women, there was a family history of diabetes,
and 9% had previously had gestational diabetes.
No
correlation was found between babies who were
either large or small for their gestational age
and the prepregnancy weight, weight of the mothers,
or the treatment regimen used.
Three
of the women developed polyhydramnios; one woman
developed hypertension; and one developed pre-eclampsia.
There was one intrauterine fetal death.
"We
saw complications more frequently in patients
who were diagnosed after 26 weeks of gestation,"
said Dr. Amorado-Santos. She said that when the
maternal and fetal outcomes in the current research
were compared to other Asian studies of gestational
diabetes, women and infants in her study had significantly
better outcomes (P<0.01). She attributed this
difference to the more aggressive management strategies
in the modified ASGODIP protocol.
Although
there was no correlation between fetal weight
and gestational diabetes in this study, early
screening and diagnosis of gestational diabetes
is still an important factor in prenatal care,
since control of gestational diabetes is associated
with a reduced risk of other pregnancy complications,
according to Dr. Amorado-Santos.
[Study
title: Maternal and Fetal Outcome of Patients
with Gestational Diabetes Mellitus Managed in
an Endocrine Referral Clinic According to a Modified
Protocol of the Asian Study Group on Diabetes
in Pregnancy. Abstract 20]
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