Читать книгу Gestational Diabetes - Группа авторов - Страница 57

Alongside the HAPO study, 2 other intervention trials were published concerning the choice of threshold values for GDM treatment. These were randomized control trials (RCTs), comparing active treatment versus standard care for women with mild hyperglycemia in pregnancy, at glucose levels lower than those commonly used. The definition for mild hyperglycemia in the 2005 ACHOIS trial by Crowther et al. [33] was GCT >140 mg/dL (7.8 mmol/L) and a 75 g OGTT fasting glucose <140 mg/dL (7.8 mmol/L) and 140–198 mg/dL (7.8–11.0 mmol/L) at 1 and 2 h. Landon et al. [34] recruited GCT-positive women with at least 2 out of 3 abnormal OGTT, but with FPG <95 mg/dL (5.3 mmol/L).

The results of these studies demonstrated that intervention, by lifestyle modification, diet, and insulin resulted in improved pregnancy outcome. In both trials, treatment of mild GDM reduced birth weight, LGA, preeclampsia, and cesarean delivery reduced in one of the RCTs.

Because of significant overlap between glucose values used for inclusion in the RCTs and those recommended by the IADPSG, it was used as an evidence to back IADPSG consensus. However, the extrapolation of conclusion from any of these 2 trials to support the IADPSG criteria may be misplaced as the methodology of the trials versus the HAPO, were dissimilar [35–37]. First, a 2-stage screening (GCT) and diagnosis (75 or 100 g OGTT) were used to select the women to participate in the RCTs, and not a single-step diagnostic 75 g OGTT, as in the HAPO. Also, the inclusion criteria and the level of glycemia considered eligible were different.