Gestational diabetes & diabetes in pregnancy
Treatment Versus Observation in Early Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors' conclusion
The SRM demonstrates early intervention does not improve most pregnancy outcomes, except NRD. Sensitivity analysis, excluding the lifestyle-only study, additionally revealed a reduction in macrosomia. The findings must be interpreted cautiously due to the variability in study designs. Replication in well-designed multicenter trials is required before clinical application.
Study context
- Population
- Pregnancies with early GDM (elevated glucose not meeting overt diabetes criteria before 20 weeks gestation)
- Participants
- 4,427 pregnancies7 randomized controlled trial (RCTs)
- Comparison
- Early treatment vs observation for early GDM
- Outcome
- Neonatal: Large-for-gestational age (LGA) and macrosomia; maternal: pregnancy-related hypertension
Methodological detailsStudies differed in timing and methods of inclusion
- Studies differed in timing and methods of inclusion
Pooled result
As reported in the abstract
Further pooled results
Neonatal respiratory distress (NRD)
- NRD significantly reduced in the treatment arm, OR
- 0.52 (0.34-0.80; P = .003) (95% CI; P)
- Only secondary outcome significantly reduced
Other secondary outcomes (NICU admission, small-for-gestational age, cord-blood C-peptide ≥90th percentile, neonatal hypoglycemia, cesarean section (CS), emergency CS, labor induction, preeclampsia, preterm birth)
- Not significantly reduced by early treatment
Macrosomia, sensitivity analysis omitting the lifestyle-only study
- Lower risk of macrosomia with early intervention, OR
- 0.55 (0.34-0.91; P = .02) (95% CI; P)
- Sensitivity analysis
Original publication
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