Treating hyperglycemia in early pregnancy: a randomized controlled trial.

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Perinatal Medicine

Background:

• Third-trimester treatment of gestational diabetes mellitus (GDM) improves perinatal outcomes.
• The benefit of treating mild glucose intolerance earlier in pregnancy on maternal and neonatal morbidities is unknown.

Purpose of the Study:

• To determine if immediate treatment of hyperglycemia in early pregnancy improves maternal and neonatal outcomes.
• To compare early pregnancy treatment versus third-trimester treatment for hyperglycemia.

Main Methods:

• An unblinded randomized controlled trial enrolled women with hyperglycemia (HbA1c ≥5.7% or fasting glucose ≥92 mg/dL) at ≤15 weeks gestation.
• Participants received either early or third-trimester treatment including nutrition counseling, glucose monitoring, and medication if needed.
• Primary outcome was neonatal umbilical cord C-peptide levels; secondary outcomes included neonatal fat mass, birth weight percentile, and maternal weight gain.

Main Results:

• The trial was terminated early with 157 participants (82 early treatment, 75 third-trimester treatment).
• No significant differences were observed in primary or secondary outcomes, including neonatal C-peptide levels, fat mass, birth weight percentile, macrosomia, or maternal gestational weight gain.
• Gestational diabetes mellitus diagnosis rates were similar between the early (14.2%) and third-trimester (25.8%) treatment groups.

Conclusions:

• Early pregnancy treatment of hyperglycemia did not significantly improve maternal or neonatal outcomes compared to third-trimester treatment.
• Caution is advised when implementing intensive diabetes treatment protocols for women diagnosed with hyperglycemia in early gestation.