Randomized Controlled Trial

. 2020 Apr;37(5):475-482.

doi: 10.1055/s-0039-1681058. Epub 2019 Mar 13.

Effect of Treatment of Mild Gestational Diabetes on Long-Term Maternal Outcomes

Brian M Casey¹, Madeline Murguia Rice², Mark B Landon³, Michael W Varner⁴, Uma M Reddy, Ronald J Wapner⁵, Dwight J Rouse⁶, Joseph R Biggio Jr⁷, John M Thorp Jr⁸, Edward K Chien⁹, George R Saade¹⁰, Alan M Peaceman¹¹, Sean C Blackwell¹², J Peter Van Dorsten¹³; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network

Collaborators, Affiliations

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network:
L Moseley¹⁴, J Price¹⁴, A Sias¹⁴, K Gonzales¹⁴, Y Delira¹⁴, F Johnson¹⁵, S Wylie¹⁵, D Habash¹⁵, S Heintzman¹⁵, E Nini¹⁵, J Iams¹⁵, C Durnwald¹⁵, K Hill¹⁶, M Thompson¹⁶, A Sowles¹⁶, G Anderson¹⁶, S Bousleiman¹⁷, M Talucci¹⁷, V Carmona¹⁷, I Quezada¹⁷, A Ranzini¹⁷, M Lake¹⁸, S Davis¹⁸, M Hoffman¹⁸, S Lynch¹⁹, J Benson¹⁹, C Kitto¹⁹, L Plante¹⁹, C Tocci²⁰, Y Williams²⁰, D Allard²¹, B Anderson²¹, K Pereda²¹, E Hipolito²¹, J McNamara²¹, S Harris²², A Tita²², A McClain²², J Sheppard²², K Clark²³, B Eucker²³, S Timlin²³, K Pena²³, T Varney²³, W Dalton²⁴, C Milluzzi²⁴, P Catalano²⁴, B Mercer²⁴, A Salazar²⁵, A Acosta²⁵, S Bouse²⁵, G Hankins²⁵, S Jain²⁵, G Mallet²⁶, M-Brinson Ramos²⁶, C Collins²⁶, L Stein²⁶, M Dinsmoor²⁶, F Ortiz²⁷, B Sibai²⁷, B Rech²⁷, L Garcia²⁷, E Thom²⁸, L Doherty²⁸, L Mele²⁸, T Spangler²⁸, C Spong²⁹, S Tolivaisa²⁹

Affiliations

¹ Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
² George Washington University Biostatistics Center, Washington, District of Columbia.
³ Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
⁴ Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah.
⁵ Department of Obstetrics and Gynecology, Columbia University, New York, New York.
⁶ Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island.
⁷ Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
⁸ Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁹ Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio.
¹⁰ Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.
¹¹ Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
¹² Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas.
¹³ Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina.
¹⁴ University of Texas Southwestern Medical Center, Dallas, TX.
¹⁵ The Ohio State University, Columbus, OH.
¹⁶ University of Utah Health Sciences Center, Salt Lake City, UT.
¹⁷ Columbia University, New York, New York.
¹⁸ (St. Peter's University Hospital).
¹⁹ (Christiana Care).
²⁰ (Drexel U.).
²¹ Brown University, Providence, RI.
²² University of Alabama at Birmingham, Birmingham, AL.
²³ University of North Carolina at Chapel Hill, Chapel Hill, NC.
²⁴ MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH.
²⁵ University of Texas Medical Branch, Galveston, TX.
²⁶ Northwestern University, Chicago, IL.
²⁷ University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
²⁸ The George Washington University Biostatistics Center, Washington, DC.
²⁹ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.

PMID: 30866027
PMCID: PMC6744360
DOI: 10.1055/s-0039-1681058

Randomized Controlled Trial

Effect of Treatment of Mild Gestational Diabetes on Long-Term Maternal Outcomes

Brian M Casey et al. Am J Perinatol. 2020 Apr.

. 2020 Apr;37(5):475-482.

doi: 10.1055/s-0039-1681058. Epub 2019 Mar 13.

Authors

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network:
L Moseley¹⁴, J Price¹⁴, A Sias¹⁴, K Gonzales¹⁴, Y Delira¹⁴, F Johnson¹⁵, S Wylie¹⁵, D Habash¹⁵, S Heintzman¹⁵, E Nini¹⁵, J Iams¹⁵, C Durnwald¹⁵, K Hill¹⁶, M Thompson¹⁶, A Sowles¹⁶, G Anderson¹⁶, S Bousleiman¹⁷, M Talucci¹⁷, V Carmona¹⁷, I Quezada¹⁷, A Ranzini¹⁷, M Lake¹⁸, S Davis¹⁸, M Hoffman¹⁸, S Lynch¹⁹, J Benson¹⁹, C Kitto¹⁹, L Plante¹⁹, C Tocci²⁰, Y Williams²⁰, D Allard²¹, B Anderson²¹, K Pereda²¹, E Hipolito²¹, J McNamara²¹, S Harris²², A Tita²², A McClain²², J Sheppard²², K Clark²³, B Eucker²³, S Timlin²³, K Pena²³, T Varney²³, W Dalton²⁴, C Milluzzi²⁴, P Catalano²⁴, B Mercer²⁴, A Salazar²⁵, A Acosta²⁵, S Bouse²⁵, G Hankins²⁵, S Jain²⁵, G Mallet²⁶, M-Brinson Ramos²⁶, C Collins²⁶, L Stein²⁶, M Dinsmoor²⁶, F Ortiz²⁷, B Sibai²⁷, B Rech²⁷, L Garcia²⁷, E Thom²⁸, L Doherty²⁸, L Mele²⁸, T Spangler²⁸, C Spong²⁹, S Tolivaisa²⁹

Affiliations

¹ Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
² George Washington University Biostatistics Center, Washington, District of Columbia.
³ Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
⁴ Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah.
⁵ Department of Obstetrics and Gynecology, Columbia University, New York, New York.
⁶ Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island.
⁷ Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
⁸ Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁹ Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio.
¹⁰ Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.
¹¹ Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
¹² Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas.
¹³ Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina.
¹⁴ University of Texas Southwestern Medical Center, Dallas, TX.
¹⁵ The Ohio State University, Columbus, OH.
¹⁶ University of Utah Health Sciences Center, Salt Lake City, UT.
¹⁷ Columbia University, New York, New York.
¹⁸ (St. Peter's University Hospital).
¹⁹ (Christiana Care).
²⁰ (Drexel U.).
²¹ Brown University, Providence, RI.
²² University of Alabama at Birmingham, Birmingham, AL.
²³ University of North Carolina at Chapel Hill, Chapel Hill, NC.
²⁴ MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH.
²⁵ University of Texas Medical Branch, Galveston, TX.
²⁶ Northwestern University, Chicago, IL.
²⁷ University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
²⁸ The George Washington University Biostatistics Center, Washington, DC.
²⁹ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.

PMID: 30866027
PMCID: PMC6744360
DOI: 10.1055/s-0039-1681058

Abstract

Objective: The main purpose of this article is to evaluate whether identification and treatment of women with mild gestational diabetes mellitus (GDM) during pregnancy affects subsequent maternal body mass index (BMI), anthropometry, metabolic syndrome, and risk of diabetes.

Study design: This is a follow-up study of women who participated in a randomized controlled treatment trial for mild GDM. Women were enrolled between 5 and 10 years after their index pregnancy. Participants underwent blood pressure, height, weight, and anthropometric measurements by trained nursing personnel using a standardized approach. A nurse-assisted questionnaire regarding screening and treatment of diabetes or hypercholesterolemia, diet, and physical activity was completed. Laboratory evaluation included fasting serum glucose, fasting insulin, oral glucose tolerance test, and a lipid panel. Subsequent diabetes, metabolic syndrome, obesity, and adiposity in those diagnosed with mild GDM and randomized to nutritional counseling and medical therapy (treated) were compared with those who underwent routine pregnancy management (untreated). Multivariable analyses were performed adjusting for race/ethnicity and years between randomization and follow-up visit.

Results: Four-hundred fifty-seven women with mild GDM during the index pregnancy were included in this analysis (243 treated; 214 untreated) and evaluated at a median 7 years after their index pregnancy. Baseline and follow-up characteristics were similar between treatment groups. Frequency of diabetes (9.2 vs. 8.5%, p =0.80), metabolic syndrome (32.2 vs. 34.3%, p =0.63), as well as adjusted mean values of homeostasis model assessment for insulin resistance (2.5 vs. 2.3, p =0.11) and BMI (29.4 vs. 29.1 kg/m², p =0.67) were also not different.

Conclusion: Identification and treatment of women with mild GDM during pregnancy had no discernible impact on subsequent diabetes, metabolic syndrome, or obesity 7 years after delivery.

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

**Fig. 1**
Screening and enrollment flow diagram. GDM, gestational diabetes mellitus.

**Fig. 2**
Percent of participants in each category of body mass index, by treatment group.

See this image and copyright information in PMC

References

1. O’Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes 1964;13:278–285 - PubMed
1. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002;25(10):1862–1868 - PubMed
1. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009;373(9677):1773–1779 - PubMed
1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2018;41(Suppl 1):S13–S27 - PubMed
1. Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(06):393–403 - PMC - PubMed

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Effect of Treatment of Mild Gestational Diabetes on Long-Term Maternal Outcomes

Collaborators

Affiliations

Effect of Treatment of Mild Gestational Diabetes on Long-Term Maternal Outcomes

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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