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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National Center for Biotechnology InformationU. The publisher’s final edited version of this article is available at N Engl J Med. No potential conflict of interest relevant to this article was reported. 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.
A prospective evaluation of fetal movement screening to reduce the incidence of antepartum fetal death. Women who were in the 24th to 31st week of gestation and who met the criteria for mild gestational diabetes mellitus i. Criteria for the oral glucose tolerance test in pregnancy. The records of all enrolled women and their infants were reviewed at the time of their discharge from the hospital, and information xchois antepartum, intrapartum, and post-delivery complications was recorded.
The mean birth weight and neonatal fat mass, as well as the frequency of large-for-gestational age infants and of infants with a birth weight of achios or greater, were significantly reduced in the treatment group as compared with the control group. Screening, Enrollment, Random Assignment, and Follow-up of the Study Participants To convert the values for glucose to millimoles per liter, multiply by 0. The majority of outcomes included in the composite outcome of the ACHOIS trial were cases of shoulder dystocia, which is considered by many to be an intermediate health outcome.
There were no perinatal deaths. The primary analysis of the clinical trial was conducted according to the intention-to-treat principle.
Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.
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. Moore TR, Piacquadio K.
Persson B, Hanson U. We randomly assigned women between 24 and 34 weeks’ gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed the intervention group or routine care.
The overall rate of preeclampsia in our study was substantially lower than that in the ACHOIS study, which is probably explained by our use of more stringent diagnostic criteria. Preventive Services Task Force recommendation statement.
If a random blood glucose level of mg per deciliter 8. Women were excluded if they had preexisting diabetes, an abnormal result on a glucose screening test before 24 weeks of gestation, prior gestational diabetes, a history of stillbirth, multifetal gestation, asthma, or chronic hypertension; if they were taking corticosteroids; if there was a known fetal anomaly; or if imminent or preterm delivery was likely because of maternal disease or fetal conditions.
During the course of the trial, an external data and safety monitoring committee periodically reviewed the trial results. Matern Child Health J. The average time from the performance of the oral glucose-tolerance test to randomization was 4. 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.
Both the body-mass index at delivery and weight gain from enrollment to delivery were lower among women in the treatment group than among those in the control group Table 4. N Engl J Med. The primary outcome was a composite of stillbirth or perinatal death and neonatal complications, including hyperbilirubinemia, hypoglycemia, hyperinsulinemia, and birth trauma.
Large for gestational age — no. Respiratory distress syndrome — no. We observed no significant difference between the treatment group and the control group in the frequency of the composite primary perinatal outcome Small for gestational age — no. Biastre; University of North Carolina — K. Intensified versus conventional management of gestational diabetes.
Cord blood was collected and forwarded to a central laboratory for determination of the C-peptide level. However, more infants of women in the intervention group were admitted to the neonatal nursery 71 percent vs. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. The frequency of intravenous glucose administration in the newborn did not differ significantly between groups. Comment in N Engl J Med.
Neonatal morbidities in gestational diabetes mellitus. N Engl J Med. Women who were receiving treatment performed daily self-monitoring of their blood glucose fasting and 2-hour postprandial measurements with the use of a portable memory-based reflectance meter.
Hyperinsulinemia was defined as a cord-blood C-peptide level greater than the 95th percentile i. 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.
A total of 37 women in the treatment group required insulin therapy, as compared with 2 in the control group.
A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes
A randomized controlled trial of wtudy glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: NICU denotes neonatal intensive care unit. Fetal and neonatal physiology. Women with a fasting glucose level of 95 mg per deciliter or more on the diagnostic oral glucose-tolerance test were excluded from the study, and their condition was made known to their health care providers.
J Clin Endocrinol Metab. Increased birth weight and neonatal fat mass may have long-term health implications for achiis offspring of mothers with gestational diabetes mellitus, including an increased risk of impaired glucose tolerance and childhood obesity.