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Treatments for gestational diabetes

Treatments for gestational diabetes
Treatments for gestational diabetes
Background: gestational diabetes (GDM) affects 3% to 6% of all pregnancies. Women are often intensively managed with increased obstetric monitoring, dietary regulation, and insulin. However, there has been no sound evidence base to support intensive treatment. The key issue for clinicians and consumers is whether treatment of GDM improves perinatal outcome.

Objectives: to compare the effect of alternative treatment policies for GDM on both maternal and infant outcomes.

Search methods: we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2009) and bibliographies of relevant papers. We updated this search on 1 July 2011 and added the results to the awaiting classification section of the review.

Selection criteria: randomised controlled trials comparing alternative management strategies for women with GDM and impaired glucose tolerance in pregnancy.

Data collection and analysis: two authors and a member of the Cochrane Pregnancy and Childbirth Group's editorial team extracted and checked data independently. Disagreements were resolved through discussion with the third author.

Main results: eight randomised controlled trials (1418 women) were included. Caesarean section rate was not significantly different when comparing any specific treatment with routine antenatal care (ANC) including data from five trials with 1255 participants (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.80 to 1.12). However, when comparing oral hypoglycaemics with insulin as treatment for GDM, there was a significant reduction (RR 0.46, 95% CI 0.27 to 0.77, two trials, 90 participants).
There was a reduction in the risk of pre-eclampsia with intensive treatment (including dietary advice and insulin) compared to routine ANC (RR 0.65, 95% CI 0.48 to 0.88, one trial, 1000 participants). More women had their labours induced when given specific treatment compared to routine ANC (RR 1.33, 95% CI 1.13 to 1.57, two trials, 1068 participants). The composite outcome of perinatal morbidity (death, shoulder dystocia, bone fracture and nerve palsy) was significantly reduced for those receiving intensive treatment for mild GDM compared to routine ANC (RR 0.32, 95% CI 0.14 to 0.73, one trial, 1030 infants). There was a reduction in the proportion of infants weighing more than 4000 grams (RR 0.46, 95% CI 0.34 to 0.63, one trial, 1030 infants) and the proportion of infants weighing greater than the 90th birth centile (RR 0.55, 95% CI 0.30 to 0.99, three trials, 223 infants) of mothers receiving specific treatment for GDM compared to routine ANC. However, there was no statistically significant difference in this proportion between infants of mothers receiving oral drugs compared to insulin as treatment for GDM.

Authors' conclusions: specific treatment including dietary advice and insulin for mild GDM reduces the risk of maternal and perinatal morbidity. However, it is associated with higher risk of labour induction. More research is needed to assess the impact of different types of intensive treatment, including oral drugs and insulin, on individual short- and long-term infant outcomes
1469-493X
1-65
Alwan, Nisreen
0d37b320-f325-4ed3-ba51-0fe2866d5382
Tuffnell, Derek J.
81b6520c-df62-4f92-b7a7-881ee1658d82
West, Jane
f6167eb2-7e11-49db-80f0-57e611b20a1f
Alwan, Nisreen
9ac32330-727a-4c3a-a243-a0b64918fd7a
Alwan, Nisreen
0d37b320-f325-4ed3-ba51-0fe2866d5382
Tuffnell, Derek J.
81b6520c-df62-4f92-b7a7-881ee1658d82
West, Jane
f6167eb2-7e11-49db-80f0-57e611b20a1f
Alwan, Nisreen
9ac32330-727a-4c3a-a243-a0b64918fd7a

Alwan, Nisreen, Tuffnell, Derek J., West, Jane and Alwan, Nisreen (2009) Treatments for gestational diabetes. Cochrane Database of Systematic Reviews, 3, 1-65. (doi:10.1002/14651858.CD003395.pub2). (PMID:19588341)

Record type: Article

Abstract

Background: gestational diabetes (GDM) affects 3% to 6% of all pregnancies. Women are often intensively managed with increased obstetric monitoring, dietary regulation, and insulin. However, there has been no sound evidence base to support intensive treatment. The key issue for clinicians and consumers is whether treatment of GDM improves perinatal outcome.

Objectives: to compare the effect of alternative treatment policies for GDM on both maternal and infant outcomes.

Search methods: we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2009) and bibliographies of relevant papers. We updated this search on 1 July 2011 and added the results to the awaiting classification section of the review.

Selection criteria: randomised controlled trials comparing alternative management strategies for women with GDM and impaired glucose tolerance in pregnancy.

Data collection and analysis: two authors and a member of the Cochrane Pregnancy and Childbirth Group's editorial team extracted and checked data independently. Disagreements were resolved through discussion with the third author.

Main results: eight randomised controlled trials (1418 women) were included. Caesarean section rate was not significantly different when comparing any specific treatment with routine antenatal care (ANC) including data from five trials with 1255 participants (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.80 to 1.12). However, when comparing oral hypoglycaemics with insulin as treatment for GDM, there was a significant reduction (RR 0.46, 95% CI 0.27 to 0.77, two trials, 90 participants).
There was a reduction in the risk of pre-eclampsia with intensive treatment (including dietary advice and insulin) compared to routine ANC (RR 0.65, 95% CI 0.48 to 0.88, one trial, 1000 participants). More women had their labours induced when given specific treatment compared to routine ANC (RR 1.33, 95% CI 1.13 to 1.57, two trials, 1068 participants). The composite outcome of perinatal morbidity (death, shoulder dystocia, bone fracture and nerve palsy) was significantly reduced for those receiving intensive treatment for mild GDM compared to routine ANC (RR 0.32, 95% CI 0.14 to 0.73, one trial, 1030 infants). There was a reduction in the proportion of infants weighing more than 4000 grams (RR 0.46, 95% CI 0.34 to 0.63, one trial, 1030 infants) and the proportion of infants weighing greater than the 90th birth centile (RR 0.55, 95% CI 0.30 to 0.99, three trials, 223 infants) of mothers receiving specific treatment for GDM compared to routine ANC. However, there was no statistically significant difference in this proportion between infants of mothers receiving oral drugs compared to insulin as treatment for GDM.

Authors' conclusions: specific treatment including dietary advice and insulin for mild GDM reduces the risk of maternal and perinatal morbidity. However, it is associated with higher risk of labour induction. More research is needed to assess the impact of different types of intensive treatment, including oral drugs and insulin, on individual short- and long-term infant outcomes

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More information

Published date: July 2009
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 377791
URI: https://eprints.soton.ac.uk/id/eprint/377791
ISSN: 1469-493X
PURE UUID: 5c503c85-5e69-49e6-a44b-a8871a523d1c
ORCID for Nisreen Alwan: ORCID iD orcid.org/0000-0002-4134-8463

Catalogue record

Date deposited: 05 Jun 2015 13:36
Last modified: 10 Sep 2019 00:33

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