Updated USPSTF guidelines favor treatment of mild gestational diabetes

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1. Moderate evidence exists to suggest that treatment of gestational diabetes (GDM) is associated with a lower likelihood of preeclampsia, shoulder dystocia, and macrosomia. Little evidence exists to suggest an association of GDM treatment with short-term harm.

2. Evidence was insufficient for the association of treatment with numerous outcomes, including long-term metabolic benefit in both mother and child.

Evidence Rating Level: 1 (Excellent)

Study Rundown: This systematic review of the harms and benefits of treating gestational diabetes mellitus found moderate evidence to support a decrease in preeclampsia, shoulder dystocia, and macrosomia associated with GDM treatment. However, evidence was lacking for many outcomes associated with treatment, including long-term metabolic benefits and maternal weight gain.

The findings of this review serve as an update to the 2008 U.S. Preventive Services Task Force (USPSTF) evidence-based recommendations, which found an overall benefit to treating GDM with regard to perinatal outcomes but lacked evidence to make recommendations regarding individual outcomes. Findings are limited by a large evidence gap for many specific outcomes and highlight a need for additional RCTs to characterize clinically significant harms and benefits of GDM treatment.

Click to read the study in Annals of Internal Medicine

Click to read an associated review of GDM screening in Annals of Internal Medicine

Relevant Reading: Uptodate: Medical management and follow-up of gestational diabetes mellitus 

In-Depth [systematic review]: This systematic review included 5 randomized controlled trials and 6 cohort studies published from 1995-2012. Among pregnant women without known pre-existing diabetes who developed GDM, these studies compared outcomes between those who received GDM treatment (diet modification, glucose monitoring, and/or insulin as needed) to those who received no treatment. Primary outcomes looked at differences in preeclampsia, maternal weight gain, birth injury, shoulder dystocia, neonatal hypoglycemia, macrosomia (birth weight >4000 g), and long-term metabolic outcomes between the two groups. Two reviewers independently evaluated the methodological quality and strength of evidence of each trial based on pre-determined criteria.

Reviewers found moderate evidence to support an association between GDM treatment and decreased incidence of preeclampsia, shoulder dystocia and macrosomia. There was little evidence to suggest short-term harm associated with treatment. Low-grade evidence demonstrated no difference between treatment groups with regard to incidences of cesarean delivery, neonatal ICU admission or neonatal hypoglycemia. There was insufficient evidence to compare how the amount of maternal weight gain or long-term metabolic outcomes differed between groups.

By Maren Shapiro and Leah Hawkins, M.D.

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