Early treatment of gestational diabetes has been shown to significantly improve the health of the mother and fetus

2023-05-28 17:40:00

The new study looked at whether treatment for gestational diabetes Before the 20th week of pregnancy among pregnant women with risk factors for diabetes, improves the health of the mother and the baby, and leads to a decrease in pregnancy and childbirth complications. The study was published in the prestigious journal New England Journal of Medicine.

Through a randomized controlled study conducted in 17 hospitals in Australia, Austria, Sweden and India, more than 43,000 pregnant women were surveyed before the 20th week of pregnancy, from which 802 women with gestational diabetes as defined by the World Health Organization and at least one risk factor for diabetes were recruited.

The women were randomly divided into 2 arms: an arm that received early treatment for gestational diabetes before week 20, and an arm that received treatment later, according to the results of the 75 gram sugar loading test (OGTT) which was performed between weeks 24-28 of pregnancy (control). The study examined negative outcomes in the mother, fetus and newborn.

The results of the study showed that immediate treatment of gestational diabetes before the 20th week of pregnancy and especially before the 14th week leads to an improvement in the newborn’s indicators consisting of premature birth, traumatic birth, risk of giving birth to a large newborn (macrosomia), Imprisonment of the newborn’s shoulders during the known birth (dystocia), respiratory distress syndrome and newborn death.

Prof. David Simmons, from the School of Medicine at the University of Western Sydney, who headed the eraser noted that breathing problems in newborns requiring oxygen were reduced by almost half and the number of days needed in the neonatal intensive care unit or in the special care unit decreased by 40 percent. Furthermore, the serious damage to the mother’s birth canal and its surroundings, damage to the perineum (perineal buffer), was reduced by more than three quarters.

researchers concluded Because the study provides new evidence for pregnant women considered to be at higher risk for early screening and treatment of gestational diabetes beyond the current recommended approach of intervention at 24-28 weeks.

Tests for gestational diabetes are routinely offered during these weeks of pregnancy, while pregnant women at a higher risk of diabetes are often also tested at an early stage, so as not to “miss” a diagnosis of type 2 diabetes. If the blood sugar values ​​are higher than the norm, but still below those defined as a diagnosis of type 2 diabetes. We believed we should treat but lacked data to demonstrate the effects of such treatment on the mother or baby; We have now filled this large knowledge gap, which probably affects millions of pregnancies every year,” said Professor Simmons.

At the same time, the research team recommends additional confirmatory experiments and long-term follow-up studies of offspring in order to understand precisely what glycemic goals should be aimed for in the treatment of gestational diabetes and whether women without risk factors for diabetes can also benefit from early diabetes treatment.

This is an important study that showed that in pregnant women with abnormal sugar values ​​from the beginning of pregnancy and/or at risk of developing gestational diabetes, early treatment before week 20 of pregnancy led to a lower risk of a complex of pregnancy and birth complications, especially the newborn, compared to starting treatment after the diagnosis of gestational diabetes at week 24 -28 as usual today. Adherence to the following principles already at the beginning of pregnancy can help support a healthy pregnancy: adjust a personal nutrition plan with a dietician with a proper distribution of carbohydrates in meals, monitor sugar levels regularly throughout the day, preferably with a continuous blood sugar meter without stabbing which will reflect the state of levels at any given time The sugar will also help to understand how foods affect sugar levels, and to be under regular pregnancy monitoring. In addition, during pregnancy, it is advisable to avoid processed and industrial food, increase dietary fiber intake, exercise most days of the week and drink sufficient water according to the recommendation of the treating staff.

Dr. Mariana YaronSheSpecialist in internal medicine and endocrinology at the center DMC For the treatment of diabetes and the Institute of Endocrinology, Metabolism and HypertensionSourasky Tel Aviv Medical Center Ichilov Tel Aviv.