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Gestational Diabetes: Even Earlier Treatment Makes Sense to Protect Against Complications

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(Vienna, 15 May 2023) Tests for gestational diabetes are currently routinely offered in the 24th to 28th week of pregnancy according to the specifications of the mother-child passport examinations, so that therapy can only be initiated then if necessary. An international study with the participation of the Medical University of Vienna has now shown for the first time that treatment of gestational diabetes at an even earlier stage of pregnancy offers additional protection for babies and mothers against complications. The results of the study were published in the renowned New England Journal of Medicine.

The study examined whether treating gestational diabetes before 20 weeks of pregnancy in women who are already at high risk improves maternal and infant health and leads to a reduction in complications.
 Currently, testing for gestational diabetes is routinely offered later in pregnancy (24 to 28 weeks), and those women who are at higher risk are also tested early to rule out undiagnosed type 2 diabetes. If these glucose levels are elevated but below guideline levels suggestive of type 2 diabetes, we feel we should treat, but data has been lacking to demonstrate the effects of such treatment on the mother or baby. Co-author Alexandra Kautzky-Willer from MedUni Vienna's Department of Internal Medicine III explains, "Currently, guidelines recommend medical intervention at 24 to 28 weeks in the case of gestational diabetes. This study provides new evidence that it makes sense to screen and treat even earlier."

The randomized controlled trial, led by Western Sydney University, was conducted in 17 hospitals in Australia, Austria, Sweden and India; over 43,000 women were studied, including 802 women with a diabetes risk factor before the 20th week of pregnancy. On the part of MedUni Vienna, the Division of Endocrinology and Metabolism of the University Department of Internal Medicine III (Alexandra Kautzky-Willer and Jürgen Harreiter) and the University Department of Obstetrics and Gynecology (Herbert Kiss) were involved as members of the TOBOGM Research Group.

Avoiding severe birth complications
The study compared pregnancy outcomes of women with gestational diabetes with early initiation of treatment before 20 weeks' gestation and later initiation of treatment depending on oral glucose tolerance test (OGTT) results at 24-28 weeks' gestation.
In more than one in 20 infants, a group of serious complications was prevented, including birth defects such as bone fractures, nerve injuries, or entrapment during birth, known as shoulder dystocia. In addition, respiratory problems requiring oxygen were nearly halved in newborns, and the number of days spent in intensive care units decreased by 40 percent. In addition, severe damage in and around the mother's birth canal, known as perineal injuries, was reduced by more than three-quarters.

Jürgen Harreiter on the significance of this study: "Until now, there was a lack of data to prove the effects of such treatment on the mother or the child; this knowledge gap, which probably affects millions of pregnancies every year, has been closed by this study."
"These new findings serve as the basis for revising existing guidelines for gestational diabetes, agreeing on the best thresholds for diagnosis, and further protecting mothers and babies," adds Alexandra Kautzky-Willer.

Publication: New England Journal of Medicine
Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy
David Simmons, Jincy Immanuel, William M. Hague, Helena Teede, Christopher J. Nolan, Michael J. Peek, Jeff R. Flack, Mark McLean, Vincent Wong, Emily Hibbert, Alexandra Kautzky-Willer, Jürgen Harreiter, Helena Backman, Emily Gianatti, Arianne Sweeting, Viswanathan Mohan, Joanne Enticott, and N. Wah Cheung. for the TOBOGM Research Group*
May 5, 2023; DOI: 10.1056/NEJMoa2214956