Mom, baby both hurt by diabetes

Treating pregnant women who have even the mildest forms of gestational diabetes can benefit mother and baby, according to a study led by an Ohio State University Medical Center obstetrician.

Physicians have screened and treated women for mild gestational diabetes for almost 50 years, said Dr. Mark Landon, the hospital's interim chairman of obstetrics and gynecology. Yet no studies have been done to determine how effective those treatments are. This trial, which ran for 6 1/2 years, examined whether dietary changes and frequent glucose monitoring made a difference. "For years, some doctors thought treating mild gestational diabetes might not be necessary because no one had shown it had a benefit," Landon said.

Landon worked with a team from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, a branch of the National Institutes of Health. The results appeared last month in The New England Journal of Medicine. The study included 958 women at 15 medical centers. Half received treatment for mild gestational diabetes, and half received normal prenatal care.

Women who did not receive treatment were twice as likely to deliver babies who had excess body fat or whose shoulders got caught in the pelvis. Women who were treated also had fewer Caesarean-section deliveries and hypertensive disorders.

Landon said he has treated hundreds of women in the past 20 years for mild forms of gestational diabetes, placing them on diets and requiring them to monitor glucose levels. But even he questioned whether it was necessary to treat it aggressively. "The study shows that it is, indeed, necessary, even in this mildest form," he said.

And that's important evidence for physicians to show women when directing them to test their glucose levels four times a day, said Dr. Catherine Y. Spong, chief of the pregnancy and perinatology branch at the national institutes. "It's well worth this effort," she said. Babies born to women with gestational diabetes also have a higher risk for breathing problems, for obesity as they get older, and for type 2 diabetes when they grow up. Gestational diabetes occurs in as many as 14 percent of pregnancies in the United States, according to Landon.

Dr. Paul Robertson, president of medicine and science for the American Diabetes Association, said the study is important because it shows the good effects of treatment and monitoring. The study also showed there were no perinatal deaths among any of the babies in the study. That's good, Robertson said. But women who become diabetic before or during pregnancy should remain vigilant. "The danger is, we don't want people with diabetes saying control is not important," he said. "Take care of your glucose levels."