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Gestational diabetes mellitus (GDM) is defined by high blood sugar that develops at any time during pregnancy in women who does not have diabetes. It affects 3% to 6% of all pregnancies. GDM may be associated with pregnancy complications, difficult births, larger babies and higher rates of caesarean sections.
This review of eight studies (overall 1418 women) compares interventions and treatments for GDM and discusses their pros and cons. These are aimed to prevent pregnancy complications and to improve baby and mother outcomes.
Treatment for GDM consists of dietary therapy, self blood glucose monitoring, and the administration of Insulin if target blood glucose concentrations are not achieved with diet alone. Selected oral anti-diabetic drugs, such as Glyburide, Acarbose (Precose), or Metformin (Glucophage) may be used in some countries as well. Diabetes in pregnancy has to be followed up very closely, with monthly visits.
The present review suggests that specific interventions may be associated with better baby outcomes. For example, specific dietary advice and Insulin therapy may be associated with a lower proportion of large babies born. However it is also associated with a higher proportion of babies admitted to special care baby units. This could be because when it is known that a woman has GDM her baby will be more closely observed.
Offering specific treatment for GDM may be associated with better mother outcomes. For example, lower risk of developing pregnancy complications (as pre-eclampsia) possibly also due to close monitoring of the pregnancy. However women given specific treatments more often needed induced labor (as compared to women receiving only routine pregnancy care monitoring).
Mothers receiving oral medication had significantly lower rates of caesarean sections, and their babies were less likely to develop complications (as neonatal hypoglycemia) compared to women treated with Insulin.
Summary: this review supports the need to offer women with a diagnosis of GDM specific treatments. Oral medication seems to be associated with better baby and mother outcomes, compared to Insulin.
This review focuses on short-term outcomes while long-term, follow-up outcomes for both the mother and the baby are lacking, so are screening methods which are used to identify women with GDM.
Published By :
Cochrane database of systematic reviews
Date :
Jul 08, 2009
