Prevention of Neonatal Macrosomia in Gestational Diabetes by the Use of Intensive Dietary Therapy and Home Glucose Monitoring

Abstract

This study was undertaken to determine if intensive dietary therapy, home blood glucose monitoring, and the selective use of insulin can be effective in preventing fetal macrosomia. All patients were screened at 24 to 28 weeks' gestation using a modification of O'Sullivan's criteria. The 153 patients diagnosed as gestational diabetics by the study protocol were placed on a 1800 to 2000 Kcal American Diabetes Association diet and taught home glucose monitoring. Insulin therapy was initiated only if blood glucose control was inadequate. There were no significant differences (p greater than 0.05) between the study and reference populations in regard to mean birthweight or the incidence of macrosomia. Since our study criteria for diagnosing gestational diabetes were slightly different from those of the National Diabetes Data Group (NDDG), data from 99 patients meeting the NDDG criteria were analyzed in a similar manner. No significant differences were found between this subgroup and the reference population. Since only 7.2% of our study patients required insulin, we conclude that the incidence of fetal macrosomia in gestational diabetes can be kept equal to that of the general population by a program of intensive dietary therapy and home glucose monitoring, with insulin being used only therapeutically, not prophylactically.

Gestational diabetes and nutritional recommendations

“…The largest randomized trial to evaluate a 30% reduction in estimated energy needs included approximately 60 women in each group, but found no differences in perinatal outcomes, including infant morbidities and birth weight [37]. "Intensive dietary therapy" (defined by investigators as 1800 to 2000 kcal in the ADA diet) in one study of women with GDM reported macrosomia rates similar to a reference population [38].…”

Shoulder dystocia related fetal neurological injuries: the role of diabetic control

“…The selected time frame of the investigation rested upon the knowledge that basic principles of currently prevailing management patterns for the diagnosis and treatment of diabetes in pregnancy had been well established in America by the mid-1980's [20][21][22]. It was felt feasible therefore to define minimum standards of practice that could reasonably be considered applicable for all study years.…”

“…b) Among babies of diabetic mothers approximately 50% are born macrosomic [22], as compared to about 10% in the general population [15]. c) The rate of ≥4000 g birth weights has been estimated as 20% among borderline glucose intolerant mothers [20,21]. d) Birth weights of ≥4500 g are about 10-times more frequent among infants of diabetic than those of non-diabetic women [30].…”

“…The above findings necessitated an unattractive conclusion, namely that protection of babies from injuries required expansion of indications for elective abdominal delivery. Since effective diabetic control is known to reduce the risk of excessive fetal growth [20][21][22], and because the latter is widely considered a very important predisposing factor for shoulder dystocia [1,2,9,12], evaluation of the potential role of antenatal care in the prevention of neurological birth damage appeared a logical next step in the authors' research program.…”

Besonderheiten der Insulintherapie bei Gestationsdiabetes (GDM) - Special Aspects of Insulin Therapy in Pregnancies Complicated by Gestational Diabetes Mellitus (GDM) -

“…Dieser Anteil erstreckt sich von weniger als 30 % [2,14,32,37,44,53,111,118,123] über 30 ± 50% [14,17,32,35,62,69,107,108,123] und sogar auf 50 ± 100 % der Fälle [4,17,29,54,69,70,74,76,88].…”