Treatment of gestational diabetes improves maternal and child health, although the diagnostic criteria remain unclear.
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We randomly assigned women with a gestational age of 24 to 32 weeks in a 1:1 ratio to be assessed for gestational diabetes using lower or higher glycemic criteria for diagnosis. The lower glycemic criterion was a fasting plasma glucose level of at least 92 mg per deciliter (≥5.1 mmol per liter), a 1-hour level of at least 180 mg per deciliter (≥10.0 mmol per liter), or a level of at least 153 mg per deciliter (≥8.5 mmol per litre). The higher glycemic criterion was a fasting plasma glucose level of at least 99 mg per deciliter (≥5.5 mmol per litre) or a 2-hourly level of at least 162 mg per deciliter (≥9.0 mmol per litre). The primary outcome measure was the birth of a baby large for gestational age (defined as a birth weight above the 90th percentile by Fenton-World Health Organization standards). Secondary outcomes were maternal and child health.
A total of 4061 women underwent randomization. Gestational diabetes was diagnosed in 310 of 2022 women (15.3%) in the lower glycemic criteria group and 124 of 2039 women (6.1%) in the higher glycemic criteria group. Of the 2019 babies born to women in the lower glycemic criteria group, 178 (8.8%) were large for gestational age, and of the 2,031 babies born to women in the higher glycemic criteria group, 181 (8.9%) were large for gestational age (adjusted relative risk, 0.98; 95% confidence interval, 0.80 to 1.19; P=0.82). Induction of labour, use of health services, use of pharmacological agents and neonatal hypoglycemia were more frequent in the lower glycemic criteria group than in the higher glycemic criteria group. The results for the other secondary outcomes were similar in the two study groups and there were no substantial differences between the groups in adverse events. Of the women in both groups who had glucose test results that fell between the lower and higher glycemic criteria, those treated for gestational diabetes (195 women), compared with those who were not (178 women), had maternal and child health. benefits, including fewer babies with large gestational age.
Using lower glycemic criteria for the diagnosis of gestational diabetes did not result in a lower risk of having a baby with a long gestational age than using higher glycemic criteria. (Funded by the Health Research Council of New Zealand and others; GEMS Australian New Zealand Clinical Trials Registry number, ACTRN12615000290594.)
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