Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes.

MedStar author(s):
Citation: American Journal of Obstetrics & Gynecology. 213(4):560.e1-8, 2015 Oct.PMID: 26071920Institution: MedStar Washington Hospital CenterDepartment: Obstetrics and Gynecology, Maternal-Fetal MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | Randomized Controlled Trial | Research Support, N.I.H., ExtramuralSubject headings: *Cesarean Section/sn [Statistics & Numerical Data] | *Diabetes, Gestational/th [Therapy] | *Gestational Age | *Hyperbilirubinemia/ep [Epidemiology] | *Hyperinsulinism/ep [Epidemiology] | *Hypoglycemia/ep [Epidemiology] | Adult | Diabetes, Gestational/ep [Epidemiology] | Female | Fetal Macrosomia | Humans | Hypertension, Pregnancy-Induced/ep [Epidemiology] | Infant, Newborn | Intensive Care Units, Neonatal/ut [Utilization] | Perinatal Mortality | Pre-Eclampsia/ep [Epidemiology] | Pregnancy | Pregnancy Outcome | Severity of Illness Index | Time Factors | Time-to-Treatment | Young AdultYear: 2015Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 1097-6868
Name of journal: American journal of obstetrics and gynecologyAbstract: CONCLUSION: Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes.Copyright � 2015 Elsevier Inc. All rights reserved.OBJECTIVE: The purpose of this study was to examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes mellitus (GDM) and maternal and perinatal outcomes.RESULTS: Of 958 women whose cases were analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared with those who initiated treatment at a later GA (probability value for interaction with the primary outcome, .44). Similarly, there was no evidence that other outcomes were improved significantly by earlier initiation of GDM treatment (large for GA, P = .76; neonatal intensive care unit admission, P = .8; cesarean delivery, P = .82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (P = .04), although there was not a clear cut GA trend where this outcome improved with treatment.STUDY DESIGN: We conducted a secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were assigned randomly to treatment vs usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal death. Other outcomes that were examined included the frequency of large for GA, birthweight, neonatal intensive care unit admission, gestational hypertension/preeclampsia, and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26, 27, 28, 29, and >30 weeks of gestation) and treatment group (treated vs routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences.All authors: Caritis SN, Carpenter MW, Catalano P, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Landon MB, Mele L, Palatnik A, Ramin SM, Reddy UM, Rouse DJ, Saade GR, Sciscione A, Sorokin Y, Thorp JM Jr, Varner MW, Wapner RJFiscal year: FY2016Digital Object Identifier: Date added to catalog: 2016-01-15
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 26071920 Available 26071920

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSION: Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes.Copyright � 2015 Elsevier Inc. All rights reserved.

OBJECTIVE: The purpose of this study was to examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes mellitus (GDM) and maternal and perinatal outcomes.

RESULTS: Of 958 women whose cases were analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared with those who initiated treatment at a later GA (probability value for interaction with the primary outcome, .44). Similarly, there was no evidence that other outcomes were improved significantly by earlier initiation of GDM treatment (large for GA, P = .76; neonatal intensive care unit admission, P = .8; cesarean delivery, P = .82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (P = .04), although there was not a clear cut GA trend where this outcome improved with treatment.

STUDY DESIGN: We conducted a secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were assigned randomly to treatment vs usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal death. Other outcomes that were examined included the frequency of large for GA, birthweight, neonatal intensive care unit admission, gestational hypertension/preeclampsia, and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26, 27, 28, 29, and >30 weeks of gestation) and treatment group (treated vs routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences.

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