Treat Gestational Diabetes? Absolutely!
Australian study counters worries about C-section increases

(HealthDay News) -- Mothers and babies alike apparently benefit when a woman is treated for diabetes that develops during pregnancy.

And fears that treating gestational diabetes will make a Caesarean delivery more likely are unfounded, according to an Australian study.

Nearly 10 percent of pregnant women develop at least mild gestational diabetes. These women are more likely to develop diabetes later, and their babies tend to be larger than average when born, which can lead to difficulties during birth.

Treating gestational diabetes is common in the United States, but that's often not the case elsewhere in the world. Experts have argued that treatment not only could increase the risk of Caesarean section but could induce labor and increase anxiety and depression in mothers.

To try to settle the debate, Australian researchers followed 1,000 women who were 24 weeks to 34 weeks pregnant and had gestational diabetes. They were randomly assigned to receive treatment that included dietary advice, blood glucose monitoring and insulin therapy, if needed, or to receive routine care.

Only 1 percent of the women in the treatment group had serious complications, versus 4 percent in the routine-care group. The researchers suggested that this may have been because infants born to mothers in the treatment group weighed less at birth and because fewer mothers in the treatment group developed preeclampsia, a condition with life-threatening elevations in blood pressure.

However, more infants of women in the treatment group were admitted to the neonatal nursery (71 percent versus 61 percent), and these women were more likely to have induced labor (39 percent versus 29 percent).

Rather than being negative aspects of treatment, though, the numbers may reflect more vigilance by doctors, the researchers said.

One of the big concerns -- the number of Caesarean deliveries -- was nearly identical in the two groups, at just less than a third.

The study also showed that, three months after having their babies, women who had been treated for gestational diabetes were less likely to have depression and reported having a much higher quality of life.

"This study is the most rigorous, best done study on this topic," Dr. Michael Greene, director of obstetrics at Massachusetts General Hospital in Boston, told HealthDay. "When you add the results of this methodologically rigorous large trial to everything that's gone before it, I think it's hard not to come to the conclusion that it's time for everybody to be screened and treated," Greene added.

Although the study did not address the issue of screening for gestational diabetes, Dr. Jeffrey Robinson, senior author of the study and the head of obstetrics and gynecology at The University of Adelaide, South Australia, told HealthDay that "the results indicating that serious perinatal morbidity is reduced by treatment provides a strong impetus for screening, as occurred for most recruited into the trial."

Precisely what level of blood glucose warrants treatment is among the many questions that still need to be answered, however, he said.

On the Web

To learn more about gestational diabetes, visit the American Diabetes Association online.

SOURCES: HealthDay News; Michael Greene, M.D., director of obstetrics, Massachusetts General Hospital, Boston; Jeffrey Robinson, M.B., professor and head, Department of Obstetrics and Gynaecology, The University of Adelaide, South Australia; June 16, 2005, New England Journal of Medicine; June 12, 2005, presentation, American Diabetes Association, annual meeting, San Diego
Author: Anne Thompson
Publication Date: May 31, 2006
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