Cargando…

Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial

INTRODUCTION: To compare the conventional treatment of gestational diabetes mellitus (GDM) with flexible treatment according to the measurement of fetal abdominal circumference (AC) in daily clinical practice. RESEARCH DESIGN AND METHODS: Two hundred and sixty pregnant women diagnosed with GDM befor...

Descripción completa

Detalles Bibliográficos
Autores principales: Fernández-López, Manuela, Blanco-Carnero, José Eliseo, Guardia-Baena, Juan Manuel, de Paco-Matallana, Catalina, Aragón-Alonso, Aurora, Hernández-Martínez, Antonio Miguel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9730386/
https://www.ncbi.nlm.nih.gov/pubmed/36593648
http://dx.doi.org/10.1136/bmjdrc-2022-002915
_version_ 1784845658175307776
author Fernández-López, Manuela
Blanco-Carnero, José Eliseo
Guardia-Baena, Juan Manuel
de Paco-Matallana, Catalina
Aragón-Alonso, Aurora
Hernández-Martínez, Antonio Miguel
author_facet Fernández-López, Manuela
Blanco-Carnero, José Eliseo
Guardia-Baena, Juan Manuel
de Paco-Matallana, Catalina
Aragón-Alonso, Aurora
Hernández-Martínez, Antonio Miguel
author_sort Fernández-López, Manuela
collection PubMed
description INTRODUCTION: To compare the conventional treatment of gestational diabetes mellitus (GDM) with flexible treatment according to the measurement of fetal abdominal circumference (AC) in daily clinical practice. RESEARCH DESIGN AND METHODS: Two hundred and sixty pregnant women diagnosed with GDM before week 34 were randomly placed in two groups: a control group, treated according to maternal capillary glycemia, and an experimental group, treated according to ultrasound parameters of fetal growth. The glycemic targets in the control group were blood glucose levels when fasting and 1 hour postprandial (<95/140 mg/dL). In the experimental group, glycemic targets depended on the percentile (p) of fetal AC: if AC p <75th, then blood glucose targets when fasting and at 1 hour postprandial were <120/180 mg/dL; and if AC p ≥75th, then the glycemic targets were <80/120 mg/dL. The follow-up of both groups was scheduled according to the GDM protocol of our diabetes and gestation unit. RESULTS: The study was completed by 246 pregnant women, 125 in the control group and 121 in the experimental group. In the experimental group, insulin treatment and neonatal hypoglycemia were significantly lower (p=0.018 and p 0.035, respectively). No differences were observed in large and small infants according to gestational age. However, macrosomic infants were less frequent in the experimental group, although this difference did not reach statistical significance. In terms of gestation complications, the type of delivery and its complications and the rest of the neonatal complications analyzed, no significant differences were observed. CONCLUSIONS: The treatment of flexible GDM according to the measurement of fetal AC is safe for the mother and the fetus and almost halves the number of pregnant women who require insulin treatment, without increasing the number of ultrasound checks or medical visits.
format Online
Article
Text
id pubmed-9730386
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-97303862022-12-09 Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial Fernández-López, Manuela Blanco-Carnero, José Eliseo Guardia-Baena, Juan Manuel de Paco-Matallana, Catalina Aragón-Alonso, Aurora Hernández-Martínez, Antonio Miguel BMJ Open Diabetes Res Care Metabolism INTRODUCTION: To compare the conventional treatment of gestational diabetes mellitus (GDM) with flexible treatment according to the measurement of fetal abdominal circumference (AC) in daily clinical practice. RESEARCH DESIGN AND METHODS: Two hundred and sixty pregnant women diagnosed with GDM before week 34 were randomly placed in two groups: a control group, treated according to maternal capillary glycemia, and an experimental group, treated according to ultrasound parameters of fetal growth. The glycemic targets in the control group were blood glucose levels when fasting and 1 hour postprandial (<95/140 mg/dL). In the experimental group, glycemic targets depended on the percentile (p) of fetal AC: if AC p <75th, then blood glucose targets when fasting and at 1 hour postprandial were <120/180 mg/dL; and if AC p ≥75th, then the glycemic targets were <80/120 mg/dL. The follow-up of both groups was scheduled according to the GDM protocol of our diabetes and gestation unit. RESULTS: The study was completed by 246 pregnant women, 125 in the control group and 121 in the experimental group. In the experimental group, insulin treatment and neonatal hypoglycemia were significantly lower (p=0.018 and p 0.035, respectively). No differences were observed in large and small infants according to gestational age. However, macrosomic infants were less frequent in the experimental group, although this difference did not reach statistical significance. In terms of gestation complications, the type of delivery and its complications and the rest of the neonatal complications analyzed, no significant differences were observed. CONCLUSIONS: The treatment of flexible GDM according to the measurement of fetal AC is safe for the mother and the fetus and almost halves the number of pregnant women who require insulin treatment, without increasing the number of ultrasound checks or medical visits. BMJ Publishing Group 2022-12-06 /pmc/articles/PMC9730386/ /pubmed/36593648 http://dx.doi.org/10.1136/bmjdrc-2022-002915 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Metabolism
Fernández-López, Manuela
Blanco-Carnero, José Eliseo
Guardia-Baena, Juan Manuel
de Paco-Matallana, Catalina
Aragón-Alonso, Aurora
Hernández-Martínez, Antonio Miguel
Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial
title Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial
title_full Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial
title_fullStr Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial
title_full_unstemmed Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial
title_short Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial
title_sort flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial
topic Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9730386/
https://www.ncbi.nlm.nih.gov/pubmed/36593648
http://dx.doi.org/10.1136/bmjdrc-2022-002915
work_keys_str_mv AT fernandezlopezmanuela flexibletreatmentofgestationaldiabetesmellitusadjustedaccordingtointrauterinefetalgrowthversustreatmentaccordingtostrictmaternalglycemicparametersarandomizedclinicaltrial
AT blancocarnerojoseeliseo flexibletreatmentofgestationaldiabetesmellitusadjustedaccordingtointrauterinefetalgrowthversustreatmentaccordingtostrictmaternalglycemicparametersarandomizedclinicaltrial
AT guardiabaenajuanmanuel flexibletreatmentofgestationaldiabetesmellitusadjustedaccordingtointrauterinefetalgrowthversustreatmentaccordingtostrictmaternalglycemicparametersarandomizedclinicaltrial
AT depacomatallanacatalina flexibletreatmentofgestationaldiabetesmellitusadjustedaccordingtointrauterinefetalgrowthversustreatmentaccordingtostrictmaternalglycemicparametersarandomizedclinicaltrial
AT aragonalonsoaurora flexibletreatmentofgestationaldiabetesmellitusadjustedaccordingtointrauterinefetalgrowthversustreatmentaccordingtostrictmaternalglycemicparametersarandomizedclinicaltrial
AT hernandezmartinezantoniomiguel flexibletreatmentofgestationaldiabetesmellitusadjustedaccordingtointrauterinefetalgrowthversustreatmentaccordingtostrictmaternalglycemicparametersarandomizedclinicaltrial