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Effective treatment of gestational diabetes unclear

Effective treatment of gestational diabetes unclear

Publication date: Wednesday, 12 December 2018

A recent summary of Cochrane reviews shows that lifestyle changes (including as a minimum: healthy eating, physical activity and self-monitoring of blood sugar levels) are the only intervention with enough evidence to show possible health improvements for women with gestational diabetes mellitus (GDM) and their babies.

GDM can occur in mid‐to‐late pregnancy. High blood glucose levels (hyperglycaemia) possibly have negative effects on both the woman and her baby's health in the short‐ and long‐term. Women with GDM have an increased risk of developing high blood pressure and protein in the urine (pre‐eclampsia). They also have a higher chance of developing type 2 diabetes, heart disease, and stroke later in life. Babies born to mothers with GDM are at increased risk of being large, having low blood glucose (hypoglycaemia) after birth, and yellowing of the skin and eyes (jaundice). As these babies become children, they are at higher risk of being overweight and developing type 2 diabetes.

Lifestyle interventions that include advice on diet and physical activity have become the mainstay of treatment of GDM and are mentioned in many clinical practice guidelines, despite a lack of good quality evidence.  A total of 14 Cochrane reviews were included in the study. Of these 10 provided relevant high-quality data with low risk of bias from 128 randomised controlled trials in nearly 18,000 women. Evidence ranged from high- to very low-quality.

Lifestyle intervention versus usual care probably reduces large-for-gestational age (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.50 to 0.71; 6 RCTs, n = 2994), but other studies suggested that lifestyle intervention may increase the number of inductions.

There was no convincing evidence for insulin therapy and in some studies insulin was associated with an increase in hypertensive disorders when compared to oral therapy. Other interventions such as exercise showed inconclusive results in improving the health of women with GDM.

ACTION

Further high-quality research is needed to gain insights into the best management approach for GDM although healthy eating, physical activity and blood glucose measurement may well benefit patients.

Martis R et al. Cochrane Systematic Review. Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews, 2018. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012327.pub2/full

 

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Topics covered:
Category: Evidence in Practice
Edition: Volume 3 Number 12 PCCJ Online 2018

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