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Is there a benefit to the treatment of mild gestational diabetes mellitus?

  • Mark B. Landon
    Correspondence
    Reprints: Mark B. Landon, MD, The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, 395 West 12th Ave., Suite 572, Columbus, OH 43210
    Affiliations
    Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH
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      Despite widespread acceptance of the value of screening for and treating gestational diabetes mellitus (GDM) in the United States, evidence concerning a benefit to this approach has been lacking. Confounding variables have specifically raised the question as to whether mild forms of carbohydrate intolerance are associated with increased perinatal and maternal risks. The findings of 2 recently conducted large-scale randomized clinical trials both indicate significant reductions in fetal overgrowth, shoulder dystocia, and preeclampsia with treatment. Thus, compelling evidence now exists that the benefit outweighs risks associated with the treatment of mild GDM.

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      References

        • American Diabetes Association
        Diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2006; 29: S43-S48
        • Chen Y.
        • Quick W.W.
        • Yang W.
        • et al.
        Cost of gestational diabetes in the United States in 2007.
        Popul Health Manag. 2009; 12: 165-174
        • O'Sullivan J.B.
        • Mahan C.M.
        Criteria for the oral glucose tolerance test in pregnancy.
        Diabetes. 1964; 13: 278-284
        • Buchanan T.A.
        • Kjos S.L.
        Gestational diabetes: risk or myth?.
        J Clin Endocrinol Metab. 1999; 84: 1854-1857
      1. Naylor CD. Diagnosing gestational diabetes mellitus: is the gold standard valid? Diabetes Care 189;12:565-72.

        • Casey B.M.
        • Lucas M.J.
        • McIntire D.D.
        • Leveno K.J.
        Pregnancy outcome in women with gestational diabetes compared with the general obstetric population.
        Obstet Gynecol. 1907; 90: 869-873
        • The HAPO Study Cooperative Research Group
        Hyperglycemia and adverse pregnancy outcomes.
        N Engl J Med. 2008; 358: 1991-2002
        • American College of Obstetricians and Gynecologists
        ACOG practice bulletin no. 30: gestational diabetes.
        Obstet Gynecol. 2001; 98: 525-538
        • Gabbe S.G.
        • Gregory R.P.
        • Power M.L.
        • Williams S.B.
        • Schulkin J.
        Management of diabetes mellitus by obstetrician-gynecologists.
        Obstet Gynecol. 2004; 103: 1229-1234
        • Crowther C.A.
        • Hiller J.E.
        • Moss J.R.
        • McPhee A.J.
        • Jeffries W.S.
        • Robinson J.S.
        Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.
        N Engl J Med. 2005; 352: 2477-2486
      2. Screening for gestational diabetes mellitus: US Preventive Services Task Force Recommendation Statement.
        Ann Int Med. 2008; 148: 759-765
        • Alwan N.
        • Tuffnell D.J.
        • West J.
        Treatments for gestational diabetes.
        Cochrane Database Syst Rev. 2009; (CD003395)
        • Langer O.
        • Yogev Y.
        • Most O.
        • Yexakis E.M.J.
        Gestational diabetes: the consequences of not treating.
        Am J Obstet Gynecol. 2005; 192: 989-997
        • O'Sullivan J.B.
        • Gellis S.S.
        • Dandrow R.V.
        • Tenney B.O.
        The potential diabetic and her treatment in pregnancy.
        Obstet Gynecol. 1966; 27: 683-689
        • Pirc L.K.
        • Owens J.A.
        • Crowther C.A.
        • Wilson K.
        • De Blasio M.J.
        • Robinson J.S.
        Mild gestational diabetes in pregnancy and the adipoinsular axis in babies born to mothers in the ACHOIS randomized controlled trial.
        BMC Pediatr. 2007; 7: 18-24
        • Hollander M.H.
        • Paarlberg K.M.
        • Huijes A.J.M.
        Gestational diabetes: a review of the current literature and guidelines.
        Obstet Gynecol Surv. 2007; 62: 125-136
        • Wright C.S.
        • Rifas-Shirman S.L.
        • Rich-Edwards J.W.
        • et al.
        Intrauterine exposure to gestational diabetes, child adiposity, and blood pressure.
        Am J Hypertension. 2009; 22: 215-220
        • Landon M.B.
        • Spong C.Y.
        • Thom E.
        • et al.
        A multicenter, randomized trial of treatment for mild gestational diabetes.
        N Engl J Med. 2009; 361: 1339-1348
        • Casey B.
        • Eunice Kennedy Shriver NICHD MFMU Network
        Does maternal BMI modify the beneficial effects of treatment in women with mild gestational diabetes?.
        Am J Obstet Gynecol. 2009; 201;: S107
        • Naylor C.D.
        • Sermer M.
        • Chen E.
        • Sykora K.
        Cesarean delivery in relation to birth weight and gestational glucose intolerance.
        JAMA. 1996; 275: 1165-1170