The newborns also had fewer cases of shoulder dystocia (1.5% with treatment vs. 4% without treatment), a potential emergency in which the birthing process stalls due to entrapment of the infant’s shoulders—a problem that’s more likely if a newborn is larger-than-normal. Women who were treated had fewer cases of high blood pressure or preeclampsia (8.6% vs. 13.6%) and were less likely to need a Caesarean section (about 27% vs. 33.8%) than women who were not.
David Sacks, MD, a maternal fetal medicine specialist at Kaiser Foundation Hospital, in Bellflower, Calif., says there is a disconnect between public health organizations and what doctors practice in terms of gestational diabetes. Most U.S. obstetricians have assumed that testing and treating the condition is beneficial, and the American Diabetes Association recommends screening for the condition.
“Gestational diabetes has been somewhat of an enigma for the last four decades because the benefits of treating it were not substantiated by strong evidence,” explains Dr. Sacks, who wrote an editorial that was published with the study. “Now we know that it’s a treatable disease and that’s supported by solid science.”
Although treatment regimens are fairly well-established, Dr. Sacks says that exactly when women should be treated for gestational diabetes is still unclear. Whereas the current study used a fasting-glucose-test threshold of less than 95 milligrams per deciliter in women with an abnormal oral glucose tolerance test, another large-scale randomized trial published in 2005 by Australian researchers showed similar benefits using a much higher threshold of 140 milligrams per deciliter. “A uniform definition of gestational diabetes mellitus is necessary to make valid comparisons of the results of intervention trials,” writes Dr. Sacks.
According to Dr. Landon, new criteria for the testing and treatment of gestational diabetes are being considered and may eventually lead to more women being treated for the condition.
Most women in the U.S. are screened for gestational diabetes between 24 to 28 weeks of pregnancy but may be tested even earlier if they are very obese, have a strong family history of the condition, or if they had gestational diabetes or gave birth to a large baby during previous pregnancies. If a one-hour oral glucose test is positive for elevated blood sugar, then women generally undergo a similar three-hour test in order to be diagnosed.
Although gestational diabetes usually goes away after a woman gives birth, women who have the condition are 50% more likely to develop type 2 diabetes within the next 20 years. For that reason, the American Diabetes Association recommends occasional blood-sugar testing, a healthy diet, and regular exercise even after childbirth.
Advertisement
Editor's Pick
Advertisement
