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Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes.

Abstract：

INTRODUCTION:A randomized multicenter study was conducted in the Stockholm-Örebro areas in Sweden to evaluate how treatment aiming at normoglycemia affects fetal growth, pregnancy and neonatal outcome in pregnant women with severe hyperglycemia. MATERIAL AND METHODS:Pregnant women with hyperglycemia defined as fasting capillary plasma glucose <7.0 mmol/L and a two-hour plasma glucose value ≥10.0 and <12.2 mmol/L following a 75-g oral glucose tolerance test (OGTT) diagnosed before 34 weeks of gestation were randomized to treatment (n = 33) or controls (n = 36). Women assigned to the control group were blinded for the OGTT results and received routine care. The therapeutic goal was fasting plasma glucose 4-5 mmol/L, and <6.5 mmol/L after a meal. Primary outcomes were size at birth and number of large-for-gestational age (>90th percentile) neonates. Secondary outcomes were pregnancy complications, neonatal morbidity and glycemic control. RESULTS:The planned number of participating women was not reached. There was a significantly reduced rate of large-for-gestational age neonates, 21 vs. 47%, P < 0.05. Group differences in pregnancy complications and neonatal morbidity were not detected because of limited statistical power. In total, 66.7% of the women in the intervention group received insulin. Of all measured plasma glucose values, 64.1% were in the target range, 7.2% in the hypoglycemic range and 28.7% above target values. There were no cases of severe hypoglycemia. CONCLUSIONS:Aiming for normalized glycemia in a pregnancy complicated by severe hyperglycemia reduces fetal growth but is associated with an increased rate of mild hypoglycemia.

journal_name

Acta Obstet Gynecol Scand

journal_title

Acta obstetricia et gynecologica Scandinavica

authors

Fadl HE,Gärdefors S,Hjertberg R,Nord E,Persson B,Schwarcz E,Åman J,Östlund IK,Hanson US

doi

10.1111/aogs.12717

subject

Has Abstract

pub_date

2015-11-01 00:00:00

pages

1181-7

issue

11

eissn

0001-6349

issn

1600-0412

journal_volume

94

pub_type

杂志文章,多中心研究,随机对照试验

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