Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes
Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. T A Buchanan , S L Kjos , M N Montoro , P Y Wu , N G Madrilejo , M Gonzalez , V Nunez , P M Pantoja and A Xiang Department of Medicine, Los Angeles County and University of Southern Californ...
Saved in:
Published in | Diabetes care Vol. 17; no. 4; pp. 275 - 283 |
---|---|
Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Alexandria, VA
American Diabetes Association
01.04.1994
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes.
T A Buchanan ,
S L Kjos ,
M N Montoro ,
P Y Wu ,
N G Madrilejo ,
M Gonzalez ,
V Nunez ,
P M Pantoja and
A Xiang
Department of Medicine, Los Angeles County and University of Southern California Medical Center.
Abstract
OBJECTIVE--To determine whether fetal ultrasound early in the third trimester can identify Latina with mild gestational diabetes
mellitus (GDM) whose fetuses are at risk for macrosomia and, if so, whether maternal insulin therapy can reduce that risk.
RESEARCH DESIGN AND METHODS--Study subjects included 303 consecutive women with GDM and a fasting serum glucose level < 5.8
mM on diet therapy who had a fetal ultrasound between 29 and 33 weeks gestation. Of the women, 98 (32%) had a fetal AC > or
= 75th percentile for gestational age, and 59 women completed a randomized trial of diet therapy (n = 29) or diet plus twice
daily insulin (n = 30). Maternal nutrient levels were assessed by meal tolerance testing (MTT) before and during therapy and
by capillary glucose monitoring four to seven times a day. Birth weights corrected for gestational age and neonatal glycemia
and skin folds were the primary outcome variables compared between treatment groups. RESULTS--Diet and diet-plus-insulin groups
were well matched for maternal age, prepregnancy relative weight, weight gain during pregnancy, and glycemia at entry. Insulin
therapy reduced maternal capillary (P < 0.005) and MTT (P < 0.001) glucose levels and prevented a diet-associated rise in
MTT triglyceride levels (P < 0.002). Gestational age at delivery was similar in insulin- and diet-treated groups (39.6 +/-
0.2 vs. 39.5 +/- 0.2 weeks). Birth weights (3,647 +/- 67 vs. 3,878 +/- 84 g; P < 0.02), the prevalence of large-for-gestational
age infants (13 vs. 45%, P < 0.02), and neonatal skin-fold measurements at three sites (P < 0.005) were reduced in the insulin-treated
group. Rates of transient neonatal hypoglycemia were low in both treatment groups (14 and 18%, respectively) and did not differ
significantly between groups. CONCLUSIONS--Fetal ultrasound early in the third trimester identified women with mild GDM whose
infants were at high risk for fetal macrosomia in the absence of standard glycemic criteria for insulin therapy. Insulin treatment
reduced the macrosomia, indicating that fetal ultrasound can be used to guide metabolic therapy in pregnancies complicated
by mild GDM. |
---|---|
Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23 |
ISSN: | 0149-5992 1935-5548 |
DOI: | 10.2337/diacare.17.4.275 |