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Hyperglycemia and Adverse Pregnancy Outcomes, Gestational Diabetes Treatment

Pregnant women with hyperglycemia below the threshold for gestational diabetes face increased risks for adverse pregnancy outcomes, according to a report in the New England Journal of Medicine. A study in the same issue finds metformin to be a potential initial treatment option for gestational diabetes.

In the hyperglycemia study, some 23,000 pregnant women without gestational diabetes underwent glucose tolerance testing. Researchers found that increasing levels of glucose intolerance were associated with increasing risk for adverse outcomes — heavier birth weight, cesarean section, and fetal hyperinsulinemia — but found no clear threshold for the effects.

In an open-label study on gestational diabetes, 733 women were randomized to treatment with either metformin or insulin. Neonatal complication rates did not differ between the groups.

Editorialists do not favor changing the threshold for diagnosing gestational diabetes. In Journal Watch General Medicine, Robert Rebar writes that metformin's long-term effects on the fetus are unknown and, agreeing with the editorial, says it should be compared directly with glyburide, a drug whose users in earlier studies required less supplementary insulin than metformin users did.

LINK(S):

NEJM article on hyperglycemia (Free abstract; full text requires subscription)

NEJM article on treatments (Free abstract; full text requires subscription)

NEJM editorial (Subscription required)

Journal Watch General Medicine summary (Subscription required)

Journal Watch Women's Health summary (Free)

Published in Physician's First Watch May 8, 2008