19 Aug Gestational Diabetes: Lower vs Higher Glucose Levels for Diagnosis
MedicalResearch.com Interview with:
Professor Caroline Crowther MB ChB, DCH, FRANZCOG, MD, DDU, FRCOG, CMFM
Maternal Fetal Medicine Subspecialist
Professor of Maternal & Perinatal Health
Waipapa Taumata Rau | University of Auckland
MwdicalResearch.com: What is the background for this study?
Response: Gestational diabetes is a growing and significant health problem worldwide for women affected and their babies. Treatment of gestational diabetes improves maternal and infant health but it remains unclear what degree of maternal hyperglycaemia should be used to make the diagnosis. Because of this uncertainty, recommended diagnostic criteria vary around the world.
The GEMS randomised trial assessed whether use of lower glycaemic diagnostic criteria, recommended by the International Association of Diabetes and Pregnancy Study Groups would improve perinatal health, without increasing maternal risks, compared to use of higher criteria, and to assess the effects on use of the health services.
MedicalResearch.com: What are the main findings?
Response: As expected, women in the lower criteria group were 2.5 times more likely to be diagnosed with gestational diabetes (15.3% versus 6.1%). However the birth of a large for gestational age infant, the primary outcome, was almost identical in the two diagnostic criteria groups, at nearly 9%. Most other health findings were similar between the two diagnostic groups, although babies born to mothers in the lower criteria group were more likely to be treated for neonatal hypoglycaemia, and the mothers were more likely to have their labour induced, receive pharmaceutical treatment for diabetes and use more health services compared with women in the higher group.
These main findings were strongly influenced by the women with “milder” gestational diabetes who were diagnosed and treated if in the lower criteria group but not diagnosed and treated if in the higher criteria group. Pre-eclampsia, birth of a large for gestational age infant and shoulder dystocia were less likely in women diagnosed and treated with milder gestational diabetes, compared to women with milder gestational diabetes not diagnosed and therefore not treated.
MedicalResearch.com: What should readers take away from your report?
Response: Overall, use of the lower diagnostic glycaemic criteria compared with the higher diagnostic glycaemic criteria increased the proportion of women diagnosed with gestational diabetes, did not reduce perinatal morbidity and increased the use of health services. However for the women with milder gestational diabetes there were health benefits suggested for them and their baby from detection and treatment.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: Follow up of the mothers and their children in this study will be important to assess the effects of the two different diagnostic thresholds on their later health and wellbeing.
Caroline A. Crowther, M.D., Deborah Samuel, B.Ed., Lesley M.E. McCowan, M.D., Richard Edlin, Ph.D., Thach Tran, Ph.D., and Christopher J. McKinlay, Ph.D. for the GEMS Trial Group
August 18, 2022
N Engl J Med 2022; 387:587-598
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