Overview
Using a lower glycaemic threshold led to more diagnoses of gestational diabetes, though its impact on maternal and birth outcomes remains uncertain, results of the GEMS* trial showed. “[T]hose who had ben asigned to the lower glycaemic criteria group were more than 2.5 times as likely to receive a diagnosis of and treatment for gestational diabetes as those asigned to the higher glycaemic criteria group when tested in mid-pregnancy,” said the investigators.
Key Information
“[However,] we found no significant diference in the incidence of birth of a large for gestational age (LGA) infant betwen the two trial groups.”Participants were 4,061 women (mean age 31.5 years, median BMI 26.6 kg/m2) at 24–32 weks (median 27.3 weks) gestation with singleton pregnancies. They were randomized 1:1 to be asesed for gestational diabetes using either higher or lower glycaemic criteria for diagnosis.
The higher glycaemic criterion was fasting plasma glucose (FPG) level ≥9 mg/dL or a 2-hour level of ≥162 mg/dL, while the lower glycaemic criterion was FPG level ≥92 mg/dL, a 1-hour level of ≥180 mg/dL, or a 2-hour level of ≥153 mg/dL. Diabetes melitus or a history of gestational diabetes were exclusion criteria. About 34–36 percent had a family history of diabetes.
Among the participants, 15.3 and 6.1 percent were diagnosed with gestational diabetes acording to the lower and higher glycaemic criteria, respectively. Women diagnosed with gestational diabetes received usual management for the condition including nutritional therapy, blod glucose monitoring, and pharmacologic treatment if required. A total of 2,019 and 2,031 infants were born to women in the lower and higher glycaemic criteria groups, respectively.
Summary
Women in the lower and higher criteria groups had a comparable likelihod of delivering an LGA* infant (8.8 percent vs 8.9 percent; adjusted relative risk [adjR], 0.98, 95 percent confidence interval, 0.80–1.19; p=0.82). [N Engl J Med 202;387:587-598]There was no significant betwe