N Engl J Med. 2005 Jun 16;352(24):2477-86.
Effect of treatment of gestational diabetes mellitus
on pregnancy outcomes.
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries
WS, Robinson JS; Australian Carbohydrate Intolerance
Study in Pregnant Women (ACHOIS) Trial Group.
Department of Obstetrics and Gynaecology, University
of Adelaide, Adelaide, Australia.
Background:
We conducted a randomized clinical trial
to determine whether treatment of women with
gestational diabetes mellitus reduced the risk of
perinatal complications.
Methods:
We randomly
assigned women between 24 and 34 weeks' gestation
who had gestational diabetes to receive dietary
advice, blood glucose monitoring, and insulin
therapy as needed (the intervention group) or
routine care. Primary outcomes included serious
perinatal complications (defined as death, shoulder
dystocia, bone fracture, and nerve palsy), admission
to the neonatal nursery, jaundice requiring
phototherapy, induction of labor, cesarean birth,
and maternal anxiety, depression, and health status.
Results:
The rate of serious perinatal complications
was significantly lower among the infants of the 490
women in the intervention group than among the
infants of the 510 women in the routine-care group
(1 percent vs. 4 percent; relative risk adjusted for
maternal age, race or ethnic group, and parity,
0.33; 95 percent confidence interval, 0.14 to 0.75;
P=0.01). However, more infants of women in the
intervention group were admitted to the neonatal
nursery (71 percent vs. 61 percent; adjusted
relative risk, 1.13; 95 percent confidence interval,
1.03 to 1.23; P=0.01). Women in the intervention
group had a higher rate of induction of labor than
the women in the routine-care group (39 percent vs.
29 percent; adjusted relative risk, 1.36; 95 percent
confidence interval, 1.15 to 1.62; P<0.001),
although the rates of cesarean delivery were similar
(31 percent and 32 percent, respectively; adjusted
relative risk, 0.97; 95 percent confidence interval,
0.81 to 1.16; P=0.73). At three months post partum,
data on the women's mood and quality of life,
available for 573 women, revealed lower rates of
depression and higher scores, consistent with
improved health status, in the intervention group.
Conclusions:
Treatment of gestational diabetes
reduces serious perinatal morbidity and may also
improve the woman's health-related quality of life.
