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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Jul 23
    2006

    Gestational diabetes study

    Archived User
    Hi Henci,

    I've recently been diagnosed with gestational diabetes and I'm trying to research it as much as possible. The biggest study to date appears to be this one:

    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 Jun 16;352(24):2477-86.

    I was wondering if you could comment on it please?

    Thanks! By: Nic
    Archived User
    To start with, here is the abstract for the study:

    "BACKGROUND: We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications. METHODS: We randomly assigned women between 24 and 34 weeks' gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care. Primary outcomes included serious perinatal complications (defined as death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, induction of labor, cesarean birth, and maternal anxiety, depression, and health status. RESULTS: The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P
    Archived User
    Thanks for such a thorough response, which has confirmed some of my worries about the paper. I began to have some concerns about the paper after I noticed that the authors reported the significance of the "serious perinatal complications" in the abstract as p=0.01, despite the fact that the true significance after correcting for multiple testing, reported in the results section, was p=0.04 -- a much less robust result. That seemed to me somewhat disingenuous!

    Regarding the effect on the women's mental health -- I may have misread this, but it looked like the non-intervention group were told their glucose tolerance test results just after their babies were born, and then given the health questionnaires about 3 months later. So the message they would have got was "actually we diagnosed you with a disease but we didn't treat you for it". If I knew nothing about GD and was told this, I'd be feeling pretty hard done to, in low spirits about my health, and worried that my baby might have been harmed in some way.

    Thanks for the link to your articles. The references on induction are very useful. My GD is diet-controlled, my HbA1c levels are normal and ultrasound puts the baby on the 50th centile (I'm aware of the inaccuracies of 3rd trimester ultrasound but even if there's a large margin of error it would seem unlikely that the baby is either very small or very large). However, despite these things, I've been told that they will want to induce labour at 40 weeks. I can't understand why this would be necessary if the baby and I are healthy and my blood glucose levels are with the same range as a non-diabetic pregnant woman. By: Nic
    Archived User
    You make some excellent points. I hope you will continue participating in the Forum as a commenter as well as a questioner.

    As for inducing you at 40 wks--or at any other preordained time, for that matter--remember that you are legally entitled to give your informed refusal as well as your informed consent. If you want to know more about the issues involved in informed decision-making, I recommend The Rights of Childbearing Women and Informed Decision Making, Informed Consent or Refusal. Both are on the ChildbirthConnection.org website.

    -- Henci By: Henci Goer
    Archived User
    Hi again,

    In my search for info about GD I came across an article in the September 2005 newsletter of the Australasian Diabetes in Pregnancy Sociey (located online at http://www.adips.org/content/September%202005%20Newsletter.pdf ) which had an interesting snippet about the study that you kindly commented on for me. I thought I'd post on here again as I thought you might be interested.

    The author cites personal communication with the study's lead researcher, Crowther, in saying that "the adverse outcomes in the routine care group occurred in women right across the range of abnormal GTT results, so no cutoff for increased risk was seen. The adverse outcomes in this group were not in women who had been subsequently treated for GDM either". The author appears to take this as a justification of the standard treatment of all women with abnormal GTT values, but surely what this means is that the adverse outcomes didn't arise due to impaired glucose tolerance?



    By: Nic
    Archived User
    In a word, yup. I've seen this illogic on other GD issues. More than one study reports that GD mothers are more likely to have overweight children and concludes that this is a reason for diagnosing and treating GD. Except that all of the women in the study were treated GD women, so clearly either GD wasn't the cause or treatment was ineffective. What we have here is a case of "My mind is made up; don't confuse me with the facts."

    -- Henci By: Henci Goer

    All Times America/New_York

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