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For patients with gestational diabetes (GDM), achieving glycemic control (GC) earlier in pregnancy is presumably associated with improved maternal and neonatal outcome. We sought to determine if the gestational age (GA) at which good GC is achieved affects outcome regardless of the method used to diagnose GDM.
A retrospective cohort study was performed by reviewing the charts of all patients with GDM enrolled in our Diabetes in Pregnancy Program from January 2009-May 2012. Before 10/2010, the 2-step method was used, with a 50-gm OGCT followed by a 100-gm OGTT. From 10/2010, the 75-gm OGTT 1-step method was used, as recommended by the American Diabetes Association. Exclusion criteria included: <18 years of age and initial GDM screening or testing <24 weeks or ≥34 weeks gestation. Good GC was defined as a mean glucose ≤100mg/dL over a 2 week period. Failure to achieve GC with diet modification was followed by medical therapy. Patients were analyzed based on the GA at which good GC was achieved regardless of the diagnostic method used. Patients who achieved good GC by 28, 30, 32, 34 and 36 weeks were compared to those who achieved GC later. Statistical analysis included Chi square and Student's t-test.
The study included 566 patients: 323 were diagnosed by the 2-step method and 234 by the 1-step method. At each GA, regardless of the diagnostic method used, achieving good GC was associated with earlier diagnosis, earlier enrollment in the diabetes program, earlier initiation and lower doses of medications, lower mean glucose, and lower BMI, compared to patients who achieved good GC at a later gestational age. Achieving good GC prior to 32 weeks was also associated with less LGA. The table compares patients who achieved GC before and after 30 and 32 weeks.
1Data presented as mean ± SD.
The method of diagnosing GDM appears to be less significant than reaching good GC as early in pregnancy as possible. Both the 1-step and 2-step methods are acceptable diagnostic tools providing they lead to timely intervention.