A randomized controlled trial of strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: A pilot study

被引:104
作者
Garner, P
Okun, N
Keely, E
Wells, G
Perkins, S
Sylvain, J
Belcher, J
机构
[1] UNIV OTTAWA,OTTAWA CIVIC HOSP,DEPT MED,OTTAWA,ON K1Y 4E9,CANADA
[2] UNIV OTTAWA,OTTAWA CIVIC HOSP,CLIN EPIDEMIOL UNIT,OTTAWA,ON K1Y 4E9,CANADA
[3] UNIV OTTAWA,OTTAWA CIVIC HOSP,DIV BIOCHEM,OTTAWA,ON K1Y 4E9,CANADA
[4] UNIV OTTAWA,OTTAWA GEN HOSP,DIV BIOCHEM,OTTAWA,ON K1Y 4E9,CANADA
[5] UNIV OTTAWA,OTTAWA GEN HOSP,DEPT OBSTET & GYNECOL,OTTAWA,ON K1Y 4E9,CANADA
[6] UNIV OTTAWA,OTTAWA GEN HOSP,DEPT MED,OTTAWA,ON K1Y 4E9,CANADA
[7] UNIV OTTAWA,OTTAWA GEN HOSP,CLIN EPIDEMIOL UNIT,OTTAWA,ON K1Y 4E9,CANADA
[8] UNIV ALBERTA,DEPT OBSTET & GYNECOL,EDMONTON,AB T6G 2M7,CANADA
关键词
gestational diabetes; intensive treatment; neonatal outcome;
D O I
10.1016/S0002-9378(97)70461-7
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVES: The purpose of this study was to determine whether strict maternal glycemic control for the treatment of gestational diabetes lessened the risk of fetal macrosomia, birth trauma, neonatal hypoglycemia, and operative delivery. The aim of the pilot study was to prepare for a multicenter trial by assessing patient acceptance of the study, by determining realistic accrual rates, and by detecting any major adverse outcomes in the control group that received routine obstetric care. STUDY DESIGN: The study was a prospective randomized controlled trial comparing fetal-neonatal and maternal outcomes in 300 women with gestational diabetes. Women randomized to the treatment arm were managed by strict glycemic control and tertiary level obstetric care, and women in the control arm received routine obstetric care. RESULTS: Three hundred women with gestational diabetes mellitus were studied. There was no difference in maternal age, weight, or length of gestation between groups. The treatment mean birth weight was 3437 +/- 575 gm compared with 3544 +/- 601 gm in the control group, a difference of 107 gm (not significant). Macrosomia rates were similar. There was no birth trauma in either group. The frequency of neonatal hypoglycemia and other metabolic complications was the same. The mode of delivery also showed similar patterns. The treatment group had significantly lower preprandial and postprandial glucose levels by 32 weeks' gestation; which continued to term. CONCLUSION: This pilot study suggests that intensive treatment of gestational diabetes mellitus may have little effect on birth weight, birth trauma, operative delivery, or neonatal metabolic disorders. It has demonstrated the safety of proceeding to a multicenter trial of sufficient sample size to confirm these findings.
引用
收藏
页码:190 / 195
页数:6
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