Control of
Gestational Diabetes Has Little Effect on Birth Weight
posted 05/28/03
Prompt diagnosis of gestational diabetes mellitus appears to have no bearing on
whether the fetus is large or small for its gestational age.
"We found no correlation between extremes of birth weight and pre-pregnancy weight, weight gain during pregnancy, or whether the mothers required insulin to control their diabetes," said Florence Amorado-Santos, MD, an endocrinology fellow, University of Santo Tomas Hospital, Manila, Philippines.
Dr. Amorado-Santos presented these findings on May 15th at the (AACE: ) American Association of Clinical Endocrinologists 12th Annual Meeting and Clinical Congress.She collaborated with Ma Honolina Sero-Gomez, MD, assistant professor of endocrinology, University of Santo Tomas Hospital.
The investigators set out to determine the role of diabetes management on maternal and fetal outcomes in women with gestational diabetes mellitus. Dr. Amorado-Santos noted that the women were managed with a modified protocol based on the Asian Federation of Endocrine Societies (ASEAN) Study Group on Diabetes in Pregnancy (ASGODIP), which was developed as a standard of care for gestational diabetes.
"We modified the ASGODIP protocol, [using] either the 75 g or 100 g glucose-tolerance test, while the original protocol only used the 75 g test," Dr. Amorado-Santos explained. The protocol used in the study defined the threshold of diabetes at a fasting blood glucose of over 100 mg/dL as hyperglycemic, and 1hour postprandial glucose exceeding 130 mg/dL.
Of 165 diagnosed patients, the investigators evaluated the data on 53 women. The women were initially monitored with a maternal diabetes profile, including pregestational body mass index (BMI), total pregnancy weight gain, family history of diabetes, and previous history of gestational diabetes. The participants used insulin therapy if dietary management was inadequate to control blood glucose. The investigators followed the women until their infants were delivered.
The women had a pregestational mean BMI of 23.7 kg/m2, and gained an average of 13.3 kg. Among 70% of the women, there was a family history of diabetes, and 9% had previously had gestational diabetes.
No correlation was found between babies who were either large or small for their gestational age and the prepregnancy weight, weight of the mothers, or the treatment regimen used.
Three of the women developed polyhydramnios; one woman developed hypertension; and one developed pre-eclampsia. There was one intrauterine fetal death.
"We saw complications more frequently in patients who were diagnosed after 26 weeks of gestation," said Dr. Amorado-Santos. She said that when the maternal and fetal outcomes in the current research were compared to other Asian studies of gestational diabetes, women and infants in her study had significantly better outcomes (P<0.01). She attributed this difference to the more aggressive management strategies in the modified ASGODIP protocol.
Although there was no correlation between fetal weight and gestational diabetes in this study, early screening and diagnosis of gestational diabetes is still an important factor in prenatal care, since control of gestational diabetes is associated with a reduced risk of other pregnancy complications, according to Dr. Amorado-Santos.
[Study title: Maternal and Fetal Outcome of Patients with Gestational Diabetes Mellitus Managed in an Endocrine Referral Clinic According to a Modified Protocol of the Asian Study Group on Diabetes in Pregnancy. Abstract 20]
Source: Diabetes In Control Dot Com.
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