Intended for healthcare professionals


Treatment of gestational diabetes

BMJ 2010; 340 doi: (Published 01 April 2010) Cite this as: BMJ 2010;340:c1708
  1. Sara J Meltzer, associate professor
  1. 1Departments of Medicine and Obstetrics and Gynaecology, McGill University, M9.22, McGill University Health Centre, 687 Pine Ave, W Montréal, QC, Canada H3A 1A1
  1. sara.meltzer{at}

    The question is not whether to treat, but how and who?

    Gestational diabetes mellitus is the most common medical condition complicating pregnancy, and in the face of the rising prevalence of diabetes, particularly in women of child bearing age, the problem is growing.1 2 In the linked systematic review and meta-analysis (doi:10.1136/bmj.c1395), Horvath and colleagues evaluate the effectiveness of screening, diagnosis, and treatment of gestational diabetes.3 The review concludes that treatment significantly reduces specified “combined” end points (any of perinatal death, shoulder dystocia, bone fracture, or nerve palsy) and birth trauma (fetal and maternal); in addition, one randomised controlled trial suggests a reduction in pre-eclampsia. Importantly, the outcome that responded most to treatment was the risk of large for gestational age infants (odds ratio 0.48, 95% confidence interval 0.38 to 0.62), an effect that is consistent with a previous systematic review (0.27, 0.09 to 0.76).4

    The lack of randomised trials from areas where people are most affected by diabetes, such as South East Asia and China (studies were mainly in white women), means that the results have limited applicability to other populations. The included trials also span decades, and during this time medical and obstetric care has changed dramatically.5 6

    Owing to the heterogeneity of diagnostic methods for gestational diabetes, which …

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