ECE2020 Audio ePoster Presentations Diabetes, Obesity, Metabolism and Nutrition (285 abstracts)
Randomized controlled trial of different intensities of glycemic control in women with gestational diabetes
Polina Popova 1,2 , Aleksandra Tkachuk 1 , Elena Vasukova 1 , Aleksandra Dronova 1 , Yana Bolotko 1 , Evgenii Pustozerov 3 , Elena Vasilieva 1 , Maria Kokina 1 , Olga Li 1 , Irina Zazerskaya 1 , Tatiana Pervunina 1 & Elena Grineva 1,2
1Almazov National Medical Research Centre, Institute of Endocrinology, Saint Petersburg, Russian Federation; 2Saint Petersburg Pavlov State Medical University, Department of internal deseases, Saint Petersburg, Russian Federation; 3Saint Petersburg State Electrotechnical University, Department of Biomedical Engineering, Saint Petersburg, Russian Federation
Background and aims: Current glycaemic treatment targets for women with gestational diabetes (GDM) are controversial. The aim of the study was to compare the effect of different intensities of glycaemic control in pregnant women with GDM on perinatal outcomes.
Materials and methods: Pregnant women in the 8th to 31st week of gestation were randomly assigned to 2 groups per target glycaemic levels: GDM1 (very tight glycaemic targets, fasting blood glucose (FBG) <5.1 mmol/l and <7.0 mmol/l postprandial) and GDM2 (less tight glycaemic targets, <5.3 mmol/l and <7.8 mmol/l, respectively). GDM was diagnosed according to World Health Organization (WHO 2013) criteria. Women were instructed on lifestyle changes and blood glucose monitoring. Insulin therapy was started if target blood glucose levels were exceeded in 2 or more measurements per week in GDM1 and in more than 1/3 of measurements per week in GDM2 group. The primary outcome was the incidence of large for gestational age (LGA) infants.
Results: A total of 616 women were randomly assigned to the study groups: GDM1 (N = 310) and GDM2 (N = 306). The rates of LGA infants were similar between the groups (13.7% and 15.6%, for GDM1 and GDM2, respectively, P = 0.550). There were no significant differences in secondary outcomes including composite of stillbirth or perinatal death and severe neonatal morbidity (nerve palsy, bone fracture and shoulder dystocia) (2.5% and 2.1%, P = 1.0), gestational age at birth (39.0 ± 1.3 vs 38.9 ± 1.5 weeks, P = 0.224), birthweight (3423 ± 492 vs 3429 ± 539 g, P = 0.884), macrosomia (birth weight >4000 g) (12.6% vs 13.3%, P = 0.900), small-for-gestational age infant (9.8% vs 8.5%, P = 0.660), neonatal hypoglycaemia (5.9% vs 6.3%, P = 1.0), admission to the neonatal nursery (4.0% vs 5.3%, P = 0.598), pre-eclampsia (15.0% vs 15.8%, P = 0.813), cesarean delivery rate (24.3% vs 29.4%, P = 0.260), gestational weight gain (9.8 ± 6.7 vs 10.9 ± 6.3 kg, P = 0.081), any perineal trauma (27.2 vs 27.0%, P = 0.9) and induction of labor (34.2% vs 30%, P = 0,313) for GDM1 and GDM2, respectively. GDM1 group achieved lower mean FBG (4.8 ± 0.4 mmol/l vs 4.9 ± 0.5 mmol/l, P = 0.047) and mean postprandial glucose values (6.1 ± 0.5 mmol/l vs 6.3 ± 0.6 mmol/l, P < 0.001). The proportion of women prescribed with insulin was higher in GDM1 compared to GDM2 group (45.5% and 26.5%, P < 0.001).
Conclusion: There were no clear differences in perinatal outcomes between the groups of women receiving very tight and less tight glycaemic targets. The frequency of insulin prescription was substantially higher in the very tight glycemic control arm.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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