TY - JOUR
T1 - Flexible treatment of gestational diabetes modulated on ultrasound evaluation of intrauterine growth
T2 - A controlled randomized clinical trial
AU - Bonomo, M.
AU - Cetin, I.
AU - Pisoni, M. P.
AU - Faden, D.
AU - Mion, E.
AU - Taricco, E.
AU - De Santis, M. Nobile
AU - Radaelli, T.
AU - Motta, G.
AU - Costa, M.
AU - Solerte, L.
AU - Morabito, A.
PY - 2004/6
Y1 - 2004/6
N2 - 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.
AB - 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.
KW - Abdominal circumference
KW - Fetal growth
KW - Gestational diabetes mellitus
KW - Pregnancy
KW - Ultrasound
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M3 - Article
C2 - 15223975
AN - SCOPUS:3142736331
VL - 30
SP - 237
EP - 243
JO - Diabetes and Metabolism
JF - Diabetes and Metabolism
SN - 1262-3636
IS - 3 I
ER -