Gestational diabetes: early intervention has slight advantages

Standard GD screening occurs between the 24th and 28th week of pregnancy. A new study compared treatment before week 20 with the traditional model.

When is treatment usually started for gestational diabetes?

Gestational diabetes: wait or act?

It is estimated that around 9 per cent of all pregnant women develop gestational diabetes. This makes the sugar metabolism disorder the most common endocrinological disease in pregnancy.

Due to the drastic effects that untreated gestational diabetes can have on the unborn child and the expectant mother, it is increasingly being discussed whether earlier screening and therefore earlier treatment is associated with better outcomes.

What does gestational diabetes mean for the unborn child?

A recent study addressed this issue and compared the outcomes between early treatment and the standard model.

The outcomes here are primarily neonatal complications such as macrosomia, premature birth, respiratory problems in the newborn, but also stillbirths and infant death. Effects on maternal health were also measured, namely through the prevalence of hypertensive pregnancy diseases such as pre-eclampsia, eclampsia or high blood pressure.

Early or late therapy: which performed better?

The researchers randomised around 800 pregnant women 1:1 into two groups. The expectant mothers were all diagnosed with gestational diabetes before the 20th week of pregnancy. The first arm of the study received antidiabetic treatment immediately after diagnosis, while the second arm underwent another oral glucose tolerance test in the 24th to 28th week of pregnancy and then received treatment as necessary.

This showed that earlier treatment of gestational diabetes has hardly any advantages over the standard later therapy. However, it was clear that there were moderately fewer neonatal complications overall in the group with the earlier intervention. There was no difference with regard to hypertensive pregnancy diseases.

Take away for medical practice

Earlier diabetes screening in pregnancy and the associated earlier treatment appear to be associated with better neonatal outcomes than later intervention. Nevertheless, the differences are relatively small, so that only further studies on this topic could provide more clarity.

  1. Simmons D, Immanuel J, Hague WM, Teede H, Nolan CJ, Peek MJ, Flack JR, McLean M, Wong V, Hibbert E, Kautzky-Willer A, Harreiter J, Backman H, Gianatti E, Sweeting A, Mohan V, Enticott J, Cheung NW; TOBOGM Research Group. Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy. N Engl J Med. 2023 Jun 8;388(23):2132-2144.