I saw this on American Pharmacist Association, I thought I would share it with you all
” FOCUS ON DIABETES CARE Charles D. Ponte, Section Advisor
Treatment of gestational diabetes lowers risk of perinatal complications
Key point: In a systematic review and meta-analysis, women with gestational diabetes who were treated with specific interventions versus usual care were at a lower risk for preeclampsia, and their infants were at a lower risk for shoulder dystocia or being large for gestational age.
Finer points: Results of a systematic review and meta-analysis of 18 trials evaluating the effects of different treatments in women with gestational diabetes were published online in BMJ. The researchers conducted two analyses: the first analysis of five trials (n = 2,999) compared specific treatments for gestational diabetes, such as dietary modifications and insulin, to usual care, and the second analysis of 13 trials (n = 1,934) compared different treatments of varying intensities (e.g., insulin twice daily vs. four times daily). The majority of trials diagnosed women with gestational diabetes using a two-step screening process involving a 50-g glucose challenge test or assessing for risk factors followed by a 75-g to 100-g oral glucose tolerance test.
Data from the first analysis showed no differences between treatment groups in terms of maternal or perinatal/neonatal mortality, birth trauma, being in the neonatal intensive care unit, or maternal development of diabetes later in life. Although one trial reported a significant reduction in cesarean sections in women in the intervention group (27% vs. 34%, P = 0.02), a pooled analysis of data from four of the five trials resulted in an odds ratio (OR) of 0.86 (95% CI 0.72–1.02, P = NS). Preeclampsia was only assessed in one trial; according to results from that study, women in the intervention group had a significantly lower risk for developing preeclampsia (2.5% vs. 5.5%. P = 0.02). Other significant differences in favor of the intervention group were shoulder dystocia (OR 0.40 [95% CI 0.21–0.75], pooled data from two trials) and large for gestational age (0.48 [0.38–0.62], pooled data from four trials). In the second analysis, a significant difference in favor of more intensive treatment was only seen for shoulder dystocia (0.31 [0.14–0.70], P = 0.005). The investigators concluded that compared with usual care, specific interventions such as daily self-management, diet, and/or pharmacotherapy are beneficial in reducing some perinatal complications.
What you need to know: Gestational diabetes affects approximately 5% to 9% of pregnant women in the United States, and its prevalence is rising. In addition to the current analysis, other studies have shown that neonatal outcomes such as death, shoulder dystocia, bone fracture, and nerve palsy were reduced when specific interventions were used to manage gestational diabetes. First-line therapies include dietary modifications, such as carbohydrate counting with meal-specific recommendations, and moderate exercise. If these interventions fail to meet glycemic goals, insulin is initiated in the majority of women. Recent data suggest that glyburide or metformin may also be safe and effective to use in this patient population. Women with gestational diabetes are also at higher risk of developing diabetes in the future; therefore, lifestyle modifications should be continued and they should be screened more regularly.
What your patients need to know: Counsel women with gestational diabetes on the importance of maintaining euglycemia. Educate them on specific measures such as dietary modifications, exercise, and appropriate use of prescribed medications.
Sources:
* Horvath K et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis [posted online April 1, 2010]. BMJ.
* Meltzer SJ. Treatment of gestational diabetes [posted online April 1, 2010]. BMJ.
Related resource on www.pharmacist.com:
* Pharmacy Today, February 2010: Counseling pearls for pregnant, breastfeeding women.
Posted by Alex Egervary (aegervary@aphanet.org) on http://www.pharmacist.com
May 17, 2010, 9:15 am “
