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Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0002-2691-7525
Department of Obstetrics and Gynecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
UltraGyn Clinic, Stockholm, Sweden.
Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
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2015 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 11, 1181-1187 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: A randomized multicenter study was conducted in the Stockholm-orebro areas in Sweden to evaluate how treatment aiming at normoglycemia affects fetal growth, pregnancy and neonatal outcome in pregnant women with severe hyperglycemia.

Material and methods: Pregnant women with hyperglycemia defined as fasting capillary plasma glucose <7.0 mmol/L and a two-hour plasma glucose value 10.0 and <12.2 mmol/L following a 75-g oral glucose tolerance test (OGTT) diagnosed before 34 weeks of gestation were randomized to treatment (n=33) or controls (n=36). Women assigned to the control group were blinded for the OGTT results and received routine care. The therapeutic goal was fasting plasma glucose 4-5 mmol/L, and <6.5 mmol/L after a meal. Primary outcomes were size at birth and number of large-for-gestational age (>90th percentile) neonates. Secondary outcomes were pregnancy complications, neonatal morbidity and glycemic control.

Results: The planned number of participating women was not reached. There was a significantly reduced rate of large-for-gestational age neonates, 21 vs. 47%, P<0.05. Group differences in pregnancy complications and neonatal morbidity were not detected because of limited statistical power. In total, 66.7% of the women in the intervention group received insulin. Of all measured plasma glucose values, 64.1% were in the target range, 7.2% in the hypoglycemic range and 28.7% above target values. There were no cases of severe hypoglycemia.

Conclusions: Aiming for normalized glycemia in a pregnancy complicated by severe hyperglycemia reduces fetal growth but is associated with an increased rate of mild hypoglycemia.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015. Vol. 94, no 11, 1181-1187 p.
Keyword [en]
Pregnancy, gestational diabetes mellitus, hyperglycemia, treatment, birthweight, compliance, large-for-gestational age
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:oru:diva-46438DOI: 10.1111/aogs.12717ISI: 000362844400006PubMedID: 26222270Scopus ID: 2-s2.0-84943587292OAI: oai:DiVA.org:oru-46438DiVA: diva2:868376
Funder
Swedish Diabetes Association
Note

Funding Agencies:

Uppsala-Örebro Regional Research Council

Praktikertjänst AB, Stockholm, Sweden

Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-10-18Bibliographically approved

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Fadl, Helena E.Schwarcz, ErikÅman, JanÖstlund, Ingrid K.Hanson, Ulf S. B.
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