sábado, 9 de enero de 2010

Mild gestational diabetes is worth treating

Maternal hyperglycaemia in pregnancy is bad for both mother and baby. Even mild gestational diabetes was associated with worse pregnancy outcomes in a recent trial. The women had normal fasting concentrations of glucose, but mildly abnormal results on a formal glucose tolerance test at 24-31 weeks’ gestation. The 473 women allocated to standard care had bigger babies (3408 g v 3302 g; P<0.001 ), more caesarean sections (33.8% v 26.9%; P=0.02), a higher risk of shoulder dystocia (4% v 1.5%; P=0.02), and a higher incidence of hypertensive disorders (13.6% v 8.6%; P=0.01) than the 485 women who were actively managed with monitoring, diet, and the option of insulin. No neonatal deaths occurred in either group, and active treatment had no effect on the combination of deaths, birth trauma, hyperbilirubinaemia, hypoglycaemia, and hyperinsulinaemia (32.4% v 37%).

Only 37 women in the treatment group needed insulin. The rest were successfully managed with dietary counselling and daily self monitoring. The treatment group gained significantly less weight than controls (2.8 kg v 5 kg; P<0.001).

This is the second big trial to suggest that women with mild gestational diabetes should be monitored and treated, says an editorial (p 1396). The first, an Australian study published four years ago, found that treated women had fewer perinatal complications and a better quality of life

Fuente: N Engl J Med 2009;361:1339-48

No hay comentarios:

Publicar un comentario