March 20, 2019

Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Women with gestational diabetes mellitus in the ACHOIS trial: risk factors . The Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) showed that treatment of pregnant women with mild gestational. diabetes mellitus – evaluation from the ACHOIS randomised trial Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial.

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Treatment of gestational diabetes mellitus, as compared with usual care, was also associated with reduced rates of preeclampsia and gestational hypertension combined rates for the two conditions, 8. Preventive Services Task Force.

National Center for Biotechnology InformationU. Ultrasonography was performed in all subjects before the oral glucose-tolerance test to confirm the gestational age. The extent to which a reduction in fetal size and in the frequency of large-for-gestational-age infants as a result of treatment may have contributed to the lower rate of cesarean deliveries is unknown.

The results from the HAPO study suggested that a threshold for an increased risk of clinical neonatal hypoglycemia may not be apparent until fasting maternal glucose levels exceed mg per deciliter 5. Intravenous glucose treatment — no.

Andrews; Brown University — D. In contrast, the frequency of small-for-gestational age infants and the frequency of admission to the neonatal intensive care unit did not differ significantly between the groups Table 3.

Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.

This randomized trial showed that although treatment of mild gestational diabetes mellitus did not reduce the frequency of the composite primary perinatal outcome, it did lower the risks of fetal overgrowth, shoulder dystocia, cesarean delivery, and preeclampsia. Hyperinsulinemia was defined as a cord-blood C-peptide level greater than the 95th percentile i.

Williams; University of Utah — K. Preventive Services Task Force achoia statement. Treatment srudy gestational diabetes reduces serious perinatal morbidity and may also improve the sfudy health-related quality of life. Table 1 Characteristics of the Study Population. Impaired glucose tolerance in adolescent offspring of diabetic mothers: The ACHOIS trial included a health status survey that showed that there were lower rates of postpartum depression in the intervention group, whereas we did not assess quality-of-life measures.


A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes

Secondary maternal outcomes included weight gain from the time acchois enrollment to delivery, gestational hypertension, preeclampsia, cesarean delivery, labor induction, and shoulder dystocia. We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications.

Sharp; University of Pittsburgh — S. The primary study out come was a composite outcome that included perinatal mortality stillbirth or neonatal death and complications that have been associated with maternal hyperglycemia: Bernhardt; Drexel University — M.

To convert zchois values for glucose to millimoles per liter, multiply by 0. The publisher’s final edited version of this article is available at N Engl J Med.

Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.

Adjustment for the baseline reported consumption of any alcohol did not materially affect the relative risk for the primary outcome relative risk with treatment, 0. Fetal and neonatal physiology. Secondary prespecified neonatal outcome measures included birth weight greater than g, large size for gestational age defined as birth weight above the 90th percentilesmall size for gestational age birth weight below the 10th percentile16 admission to the neonatal intensive care unit, and the respiratory distress syndrome.

Screening for gestational stdy mellitus: By including this group of women who did not have gestational diabetes mellitus, the patients, their caregivers, and the study staff were unaware of whether women in the control adhois met the criteria for the diagnosis of mild gestational diabetes mellitus.

The rates of labor induction were similar between the treatment and control groups; however, cesarean delivery was significantly less common among women in the treatment group than among women in the control group Table 3 Secondary Neonatal Outcomes.


Childhood obesity and metabolic imprinting: If, during a prenatal visit, there was a clinical suspicion of hyperglycemia in a patient who was in the control group, the blood glucose level could be measured at the discretion of the provider. The diagnosis of gestational diabetes mellitus, or the knowledge that it is present, has been reported to be associated with an increase in several adverse maternal outcomes. In addition, a cohort of women who had a positive result on the g glucose loading test but a normal result on a subsequent oral glucose-tolerance test and who were matched with the study cohort according to race and body-mass index the weight in kilograms divided by the square of the height in metersdichotomized as less than 27 or 27 or more, were enrolled by the data coordinating center in the group that received usual prenatal care.

A prospective evaluation of fetal movement screening to reduce the incidence of antepartum fetal death.

A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes

In addition, we used a g diagnostic oral glucose-tolerance test, whereas a g oral glucose-tolerance test was used in the ACHOIS trial. Race or ethnic group — no. Preterm delivery — no. The primary analysis of the clinical trial was conducted according to the intention-to-treat principle.

Hypoglycemia and hyperglycemia in the newborn. All the women who pa rticipated in the study provided written informed consent.

These findings complement the ongoing analysis of the HAPO study data, which is focused on developing an international consensus for the diagnosis and treatment of carbohydrate intolerance during pregnancy.