Flexible treatment of gestational diabetes modulated on ultrasound evaluation of intrauterine growth: A controlled randomized clinical trial

M. Bonomo, I. Cetin, M. P. Pisoni, D. Faden, E. Mion, E. Taricco, M. Nobile De Santis, T. Radaelli, G. Motta, M. Costa, L. Solerte, A. Morabito

Research output: Contribution to journalArticle

Abstract

Objectives: In order to prevent abnormalities of fetal growth still characterizing pregnancies complicated by Gestational Diabetes (GDM), in the present study we evaluated a therapeutic strategy for GDM based on ultrasound (US) measurement of fetal insulin-sensitive tissues. Methods: All GDM women diagnosed before 28th week immediately started diet and self-monitoring of blood glucose; after 2 weeks they were randomized to conventional (C) or modified (M) management. In C the glycemic target (GT) was fixed at 90 fasting/120 post-prandial mg/dl; in M GT varied, according to US measurement of the Abdominal Circumference (AC) centile performed every 2 weeks: 80/100 if AC ≥ 75th, 100/140 if AC <75th. Therapy was tailored to mean fasting (FG) and postprandial glycemia (PPG). Results: Globally, 229 women completed the study, 78 in C, 151 in M. Use of insulin was 16.7% in C, 30.4% in M (total groups), significantly more frequent in M than in C (59.7% vs 15.4%) when considering only women with AC ≥ 75th C. Mean metabolic data were similar in the 2 groups, but in M a tightly-optimized subgroup, resulting from the lowering of GT due to AC ≥ 75th, coexisted with a less-controlled one, whose higher GT was justified by AC <75th. Pregnancy outcome was better in M, with lower (p <0.05*) rate of LGA* (7.9% vs 17.9%), SGA (6.0% vs 9.0%) and Macrosomia* (3.3% vs 11.5%). Conclusions: Our data show the value of a flexible US-based approach to the treatment of GDM. This model does not necessarily involve a generalized aggressive treatment, allowing to concentrate therapeutical efforts on a small subgroup of women showing indirect US evidence of fetal hyperinsulinization. Such a selective approach allowed to obtain a near-normalization of fetal growth, with clear advantages on global pregnancy outcome.

Original languageEnglish
Pages (from-to)237-243
Number of pages7
JournalDiabetes and Metabolism
Volume30
Issue number3 I
Publication statusPublished - Jun 2004

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Keywords

  • Abdominal circumference
  • Fetal growth
  • Gestational diabetes mellitus
  • Pregnancy
  • Ultrasound

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Bonomo, M., Cetin, I., Pisoni, M. P., Faden, D., Mion, E., Taricco, E., De Santis, M. N., Radaelli, T., Motta, G., Costa, M., Solerte, L., & Morabito, A. (2004). Flexible treatment of gestational diabetes modulated on ultrasound evaluation of intrauterine growth: A controlled randomized clinical trial. Diabetes and Metabolism, 30(3 I), 237-243.