מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – An approach including ultrasonic measurement of fetal abdominal circumference allows avoidance of insulin therapy in certain women with gestational diabetes mellitus (GDM).
Dr. Siri L. Kjos of the University of Southern California, in Los Angeles, and colleagues note that normalizing glucose levels in all GDM patients "may result in unnecessary use of insulin treatment in many pregnancies not at risk for fetal complications."
To investigate whether an alternative approach might be helpful, the researchers studied 98 women with GDM who had fasting plasma glucose (FPG) concentrations of 105 to 120 mg/dL. The findings appear in the November issue of Diabetes Care.
The subjects were randomized to standard management with insulin therapy or to an experimental group in whom monthly ultrasound measurements were made of fetal abdominal growth. These women received insulin if fetal growth was at or beyond the 70th percentile or if any venous FPG measurement was greater than 120 mg/dL.
Birthweight, frequency of birthweight greater than the 90th percentile, and neonatal morbidity did not differ significantly between groups. However, significantly more women in the experimental group had cesarean delivery (33.3%) compared with those who received standard care (14.6%) (p = 0.03). This, say the investigators, "was not readily explained by a failure to mitigate accelerated fetal growth."
Nevertheless, the researchers, who call for large-scale randomized trials, point out that the technique "identified pregnancies at low risk for macrosomia and resulted in the avoidance of insulin therapy in 38% of patients without increasing rates of neonatal morbidity."
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