The management of women with gestational diabetes can be stratified according to diagnostic oral glucose tolerance test results

Abstract

The ACHOIS trial (Australian Carbohydrate Intolerance Study in Pregnant Women) confirmed the benefits of treating gestational diabetes mellitus (GDM). Optimum management strategies remain uncertain. In our unit, women with GDM are allocated into two treatment groups according to their diagnostic oral glucose tolerance test (OGTT) result. Those with a fasting glucose <6mmol/L and two-hour post-load glucose of 7.8-9mmol/L are treated conservatively: dietitian-led, with weekly blood glucose test two hours post-meal; while those with a fasting glucose ≥ 6mmol/L or two-hour post-load glucose ≥ 9mmol/L are treated intensively: regular clinic reviews, with four times daily home blood glucose monitoring (HBGM). This study aimed to investigate any difference in outcomes between the conservative group (n=35) and the intensive group (n=46). Eighty-one GDM patients attending the joint obstetric clinic between May 2001 and March 2004 were identified, and pregnancy outcomes in the two groups were compared. There were no significant differences in mean birth weight (conservative group 3572±458g, intensive group 3601±666g, p=0.597), rates of macrosomia [>4kg] (conservative 20%, intensive 30%, p=0.3) and large for gestational age [>95th centile] (conservative 29%, intensive 41%, p=0.2). It was concluded that the care of women with GDM can be stratified based on diagnostic OGTT results and managed accordingly, which may allow for a more resource-efficient management strategy in this group. Copyright © 2008 John Wiley & Sons.