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Journal article
Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes
American journal of obstetrics and gynecology, v 213(4), pp 560.e1-560.e8
Oct 2015
PMID: 26071920
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
The purpose of this study was to examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes mellitus (GDM) and maternal and perinatal outcomes.
We conducted a secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were assigned randomly to treatment vs usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal death. Other outcomes that were examined included the frequency of large for GA, birthweight, neonatal intensive care unit admission, gestational hypertension/preeclampsia, and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26, 27, 28, 29, and ≥30 weeks of gestation) and treatment group (treated vs routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences.
Of 958 women whose cases were analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared with those who initiated treatment at a later GA (probability value for interaction with the primary outcome, .44). Similarly, there was no evidence that other outcomes were improved significantly by earlier initiation of GDM treatment (large for GA, P = .76; neonatal intensive care unit admission, P = .8; cesarean delivery, P = .82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (P = .04), although there was not a clear cut GA trend where this outcome improved with treatment.
Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes.
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Details
- Title
- Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes
- Creators
- Anna Palatnik - Northwestern UniversityLisa Mele - George Washington UniversityMark B Landon - The Ohio State UniversityUma M Reddy - National Institutes of HealthSusan M Ramin - The University of Texas at AustinMarshall W Carpenter - Brown UniversityRonald J Wapner - Columbia UniversityMichael W Varner - University of UtahDwight J Rouse - University of AlabamaJohn M Thorp, Jr - Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NCAnthony Sciscione - Drexel UniversityPatrick Catalano - Case Western Reserve UniversityGeorge R Saade - The University of Texas Medical Branch at GalvestonSteve N Caritis - University of PittsburghYoram Sorokin - Wayne State UniversityEunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units NetworkMichael Williams - Pharmacology and Physiology
- Publication Details
- American journal of obstetrics and gynecology, v 213(4), pp 560.e1-560.e8
- Publisher
- Elsevier
- Grant note
- HD40485 / NICHD NIH HHS U10 HD027860 / NICHD NIH HHS M01 RR000034 / NCRR NIH HHS M01-RR00080 / NCRR NIH HHS U10 HD027915 / NICHD NIH HHS HD34136 / NICHD NIH HHS U10 HD021410 / NICHD NIH HHS UG1 HD027915 / NICHD NIH HHS UG1 HD034116 / NICHD NIH HHS UG1 HD053097 / NICHD NIH HHS C06 RR011234 / NCRR NIH HHS HD40545 / NICHD NIH HHS M01 RR000080 / NCRR NIH HHS P30 DK079626 / NIDDK NIH HHS M01-RR00034 / NCRR NIH HHS U10 HD034116 / NICHD NIH HHS HD40544 / NICHD NIH HHS U10 HD053097 / NICHD NIH HHS U10 HD053118 / NICHD NIH HHS HD27917 / NICHD NIH HHS HD40560 / NICHD NIH HHS HD53097 / NICHD NIH HHS U10 HD034208 / NICHD NIH HHS UG1 HD040485 / NICHD NIH HHS U10 HD027917 / NICHD NIH HHS HD21410 / NICHD NIH HHS UG1 HD040560 / NICHD NIH HHS HD27915 / NICHD NIH HHS UG1 HD040544 / NICHD NIH HHS UG1 HD040512 / NICHD NIH HHS UG1 HD027869 / NICHD NIH HHS U10 HD034136 / NICHD NIH HHS UL1-RR024989 / NCRR NIH HHS HD27860 / NICHD NIH HHS UG1 HD040545 / NICHD NIH HHS U10 HD040500 / NICHD NIH HHS UL1 RR025764 / NCRR NIH HHS HD53118 / NICHD NIH HHS HD27869 / NICHD NIH HHS HD34208 / NICHD NIH HHS UG1 HD040500 / NICHD NIH HHS U10 HD036801 / NICHD NIH HHS U10 HD040545 / NICHD NIH HHS UL1 RR024989 / NCRR NIH HHS U10 HD040544 / NICHD NIH HHS U10 HD040512 / NICHD NIH HHS UL1-RR025764 / NCRR NIH HHS HD36801 / NICHD NIH HHS HD40512 / NICHD NIH HHS U10 HD027869 / NICHD NIH HHS HD34116 / NICHD NIH HHS U10 HD040560 / NICHD NIH HHS UG1 HD034208 / NICHD NIH HHS UL1 TR000439 / NCATS NIH HHS U10 HD040485 / NICHD NIH HHS HD40500 / NICHD NIH HHS U01 HD036801 / NICHD NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pharmacology and Physiology
- Web of Science ID
- WOS:000361879400033
- Scopus ID
- 2-s2.0-84942297615
- Other Identifier
- 991019173638404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Obstetrics & Gynecology