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DOI: 10.1055/s-0035-1563715
Early Screening and Treatment of Women with Prediabetes: A Randomized Controlled Trial
Publikationsverlauf
04. Juni 2015
21. Juli 2015
Publikationsdatum:
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.
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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References
- 1 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33 (Suppl. 01) S62-S69
- 2 International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009; 32 (7) 1327-1334
- 3 Gregg EW, Geiss L, Zhang P, Zhuo X, Williamson DF, Albright AL. Implications of risk stratification for diabetes prevention: the case of hemoglobin A1c. Am J Prev Med 2013; 44 (4) (Suppl. 04) S375-S380
- 4 Metzger BE, Gabbe SG, Persson B , et al; International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33 (3) 676-682
- 5 California Diabetes in Pregnancy Program [Internet] Cited November 29, 2014. http://www.cdappsweetsuccess.org
- 6 Fong A, Serra AE, Gabby L, Wing DA, Berkowitz KM. Use of hemoglobin A1c as an early predictor of gestational diabetes mellitus. Am J Obstet Gynecol 2014; 211 (6) 641.e1-641.e7
- 7 Hughes RCE, Moore MP, Gullam JE, Mohamed K, Rowan J. An early pregnancy HbA1c ≥5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care 2014; 37 (11) 2953-2959
- 8 Hanas R, John G ; International HBA1c Consensus Committee. 2010 consensus statement on the worldwide standardization of the hemoglobin A1C measurement. Diabetes Care 2010; 33 (8) 1903-1904
- 9 IOM (Institute of Medicine) and NRC (National Research Council). Weight Gain during Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press; 2009
- 10 Lowe LP, Metzger BE, Dyer AR , et al; HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care 2012; 35 (3) 574-580
- 11 Coustan DR, Lowe LP, Metzger BE, Dyer AR ; International Association of Diabetes and Pregnancy Study Groups. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus. Am J Obstet Gynecol 2010; 202 (6) 654.e1-654.e6
- 12 Black MH, Sacks DA, Xiang AH, Lawrence JM. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care 2013; 36 (1) 56-62
- 13 Quinlivan JAJ, Julania S, Lam L. Antenatal dietary interventions in obese pregnant women to restrict gestational weight gain to Institute of Medicine recommendations: a meta-analysis. Obstet Gynecol 2011; 118 (6) 1395-1401
- 14 Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med 2012; 10 (1) 47
- 15 Landon MB, Spong CY, Thom E , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361 (14) 1339-1348
- 16 Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS ; Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352 (24) 2477-2486
- 17 Bartha JL, Martinez-Del-Fresno P, Comino-Delgado R. Gestational diabetes mellitus diagnosed during early pregnancy. Am J Obstet Gynecol 2000; 182 (2) 346-350
- 18 Most OL, Kim JH, Arslan AA, Klauser C. Maternal and neonatal outcomes in early glucose tolerance testing in an obstetric population in New York city. J Perinat Med 2009; 37 (2) 114-117
- 19 Luoto R, Kinnunen TI, Aittasalo M , et al. Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counseling: a cluster-randomized controlled trial. PLoS Med 2011; 8 (5) e1001036
- 20 Harrison CL, Lombard CB, Strauss BJ, Teede HJ. Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. Obesity (Silver Spring) 2013; 21 (5) 904-909
- 21 Hiramatsu Y, Shimizu I, Omori Y, Nakabayashi M ; JGA (Japan Glycated Albumin) Study Group. Determination of reference intervals of glycated albumin and hemoglobin A1c in healthy pregnant Japanese women and analysis of their time courses and influencing factors during pregnancy. Endocr J 2012; 59 (2) 145-151