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Am J Perinatol 2016; 33(02): 172-179
DOI: 10.1055/s-0035-1563715
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early Screening and Treatment of Women with Prediabetes: A Randomized Controlled Trial

Sarah S. Osmundson
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Mary E. Norton
2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
,
Yasser Y. El-Sayed
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Susan Carter
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Jeffrey C. Faig
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
John L. Kitzmiller
3   Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California
› Author Affiliations
Further Information

Publication History

04 June 2015

21 July 2015

Publication Date:
07 September 2015 (online)

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Abstract

Objective To examine whether women with prediabetes benefit from early treatment for gestational diabetes mellitus (GDM).

Study Design Women with a glycosylated hemoglobin A1C (A1C) of 5.7 to 6.4% at <14 weeks were recruited. Participants were randomized to usual care or treatment for GDM with diet, blood glucose monitoring, and insulin as needed. The primary outcome was a 75-g oral glucose tolerance test at 26 to 28 weeks. Secondary outcomes included cesarean delivery, birthweight, weight gain, and A1C change.

Results Between May 2012 and June 2014, 95 women were enrolled and 83 had data for analysis; 42 were randomized to treatment and 41 to usual care. The groups were similar in baseline characteristics with 40% obese. There was no difference in the primary outcome (treatment 45.2% vs. control 56.1%; relative risk [RR] 0.80; 95% confidence interval [CI] 0.53–1.24) except that women in the treatment group had a significantly lower A1C over time than women in the control group (p = 0.04). Nonobese women (n = 50) treated for GDM experienced a 50% reduction in GDM compared with controls (29.6 vs. 60.9%; RR 0.49; 95% CI 0.25–0.95).

Conclusion Early treatment for women with a first-trimester A1C of 5.7 to 6.4% did not significantly reduce the risk of GDM except in nonobese women.

Keywords

early treatment - gestational diabetes mellitus - hemoglobin A1C - prediabetes

Note

This study was presented as an oral presentation at the Society for Maternal-Fetal Medicine Annual Meeting, February 3–7, 2015, San Diego, CA.


 

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