Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy

This multicenter randomized controlled trial evaluated the effects of immediate treatment versus deferred/no treatment for gestational diabetes mellitus (GDM) diagnosed before 20 weeks’ gestation in 802 high-risk women. The primary outcomes were a composite of adverse neonatal events (preterm birth, birth trauma, respiratory distress, etc.), pregnancy related hypertension, and neonatal lean body mass. Immediate treatment resulted in a modest reduction in adverse neonatal outcomes (24.9% vs. 30.5%; adjusted risk difference 5.6%, 95% CI 10.1 to .2), but no significant differences in pregnancy related hypertension (10.6% vs. 9.9%) or neonatal lean body mass (2.86 kg vs. 2.91 kg). Respiratory distress was the primary driver of neonatal benefit. The study supports immediate treatment for early GDM to reduce neonatal complications, though further research is needed to refine diagnostic criteria and assess long term outcomes.

This multicenter randomized controlled trial evaluated the effects of immediate treatment versus deferred/no treatment for gestational diabetes mellitus (GDM) diagnosed before 20 weeks’ gestation in 802 high-risk women. The primary outcomes were a composite of adverse neonatal events (preterm birth, birth trauma, respiratory distress, etc.), pregnancy related hypertension, and neonatal lean body mass. Immediate treatment resulted in a modest reduction in adverse neonatal outcomes (24.9% vs. 30.5%; adjusted risk difference 5.6%, 95% CI 10.1 to .2), but no significant differences in pregnancy related hypertension (10.6% vs. 9.9%) or neonatal lean body mass (2.86 kg vs. 2.91 kg). Respiratory distress was the primary driver of neonatal benefit. The study supports immediate treatment for early GDM to reduce neonatal complications, though further research is needed to refine diagnostic criteria and assess long term outcomes.