A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes

• Published in: The New England journal of medicine Vol. 361; no. 14; pp. 1339 - 1348
• Main Authors: Landon, Mark B, Spong, Catherine Y, Thom, Elizabeth, Carpenter, Marshall W, Ramin, Susan M, Casey, Brian, Wapner, Ronald J, Varner, Michael W, Rouse, Dwight J, Thorp, John M, Sciscione, Anthony, Catalano, Patrick, Harper, Margaret, Saade, George, Lain, Kristine Y, Sorokin, Yoram, Peaceman, Alan M, Tolosa, Jorge E, Anderson, Garland B
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 01.10.2009
• Subjects: Adult; Biological and medical sciences; Birth Weight; Body Mass Index; Cesarean Section - statistics & numerical data; Combined Modality Therapy; Diabetes; Diabetes, Gestational - blood; Diabetes, Gestational - diet therapy; Diabetes, Gestational - drug therapy; Female; Fetal Macrosomia - prevention & control; General aspects; Glucose; Glucose Tolerance Test; Humans; Hypoglycemic Agents - therapeutic use; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Infant, Newborn, Diseases - prevention & control; Insulin - therapeutic use; Medical sciences; Perinatal Mortality; Pregnancy; Pregnancy Outcome; Premature Birth - epidemiology; Stillbirth - epidemiology; Womens health; Medicine; Clinical trial; Randomization; Treatment; Gestational diabetes; Multicenter study
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa0902430

In this randomized trial of treatment versus no treatment for mild gestational diabetes mellitus, rates of the primary outcome (a composite of stillbirth or perinatal death and neonatal hyperbilirubinemia, hypoglycemia, hyperinsulinemia, or birth trauma) did not differ significantly between groups. However, there were significant reductions with treatment in several secondary outcomes, including the frequency of large-for-gestational-age infants, shoulder dystocia, cesarean delivery, and hypertension in pregnancy. In this randomized trial of treatment versus no treatment for mild gestational diabetes mellitus, rates of the primary outcome (a composite of stillbirth or perinatal death and neonatal hyperbilirubinemia, hypoglycemia, hyperinsulinemia, or birth trauma) did not differ significantly between groups. However, there were significant reductions with treatment in several secondary outcomes. Gestational diabetes mellitus is defined as glucose intolerance that first occurs or is first identified during pregnancy. 1 The frequency of this condition is rising in the United States and occurs in 1 to 14% of all pregnancies, depending on varying characteristics of the population. 2 More than 40 years ago, O'Sullivan and Mahan developed glucose-tolerance-test criteria for the diagnosis of gestational diabetes mellitus. 3 The diagnostic thresholds that they developed were based on the subsequent development of adult-onset diabetes and were not predicated on any association between carbohydrate intolerance discovered during gestation and adverse pregnancy outcomes. Although gestational diabetes mellitus is a . . .