OBJECTIVE -To identify the impact of suboptimal blood glucose control on neonatal outcomes in women with gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS -Included were patients with singleton gestation enrolled in an outpatient GDM management program for at least 7 days who delivered at term. Blood glucose control was defined as an average fasting blood glucose of Ͻ95 mg/dl, 1-h postprandial of Ͻ140 mg/dl, or 2-h postprandial of Ͻ120 mg/dl. Data were compared between patients with optimal blood glucose control (n ϭ 2,030) and those with suboptimal blood glucose control (n ϭ 1,188). The primary study outcome was a composite variable consisting of macrosomia, large-for-gestational-age, hypoglycemia, jaundice, or stillbirth.RESULTS -Over one-third of infants in the poorly controlled group were positive for at least one factor comprising the composite variable compared with 24% from the controlled group (P Ͻ 0.001).CONCLUSIONS -Suboptimal glycemic control in women with GDM is associated with adverse neonatal outcome. Careful monitoring of blood glucose levels and initiation of appropriate treatment are essential in the care of women with GDM.
Diabetes Care 30:467-470, 2007G estational diabetes mellitus (GDM) affects 2-5% of pregnancies in the U.S. (1). GDM is defined as a carbohydrate intolerance that begins or is first diagnosed during pregnancy (2). Pregnancies complicated with GDM are at increased risk for cesarean delivery and labor abnormalities as well as adverse neonatal outcomes such as macrosomia, hypoglycemia, stillbirth, and neonatal intensive care unit admission (3). Yet, questions remain regarding the beneficial effects of identification and treatment of GDM, the consequences of failure to diagnose the condition, and the degree of glycemic control necessary during pregnancy (4). Recently, the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) trial revealed that treatment of GDM does improve pregnancy outcome (5).Current clinical interventions for patients diagnosed with GDM focus on maintaining euglycemia with a combination of diet and exercise. When diet and exercise fail to normalize blood glucose levels, insulin therapy is recommended.The purpose of this analysis was to compare neonatal outcomes in women diagnosed with GDM whose average blood glucose values were within recommended American College of Obstetricians and Gynecologists guidelines with those with higher-than-recommended blood glucose averages.
RESEARCH DESIGN AND METHODS -The study population was identified retrospectively from a large centralized perinatal database containing de-identified clinical information on pregnant women receiving outpatient services for surveillance and management of GDM through Matria Healthcare between January 2001 and January 2005. Information stored in the database was collected prospectively from the patient and her health care provider at initiation of outpatient services, as well as during the course of care, and included medical and obstetrical history, current pregnancy...
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