Early Gestational Diabetes Treatment: A Game Changer for Moms and Babies

A groundbreaking study investigated whether treating gestational diabetes before the 20th week of pregnancy in expectant mothers with diabetes risk factors could improve both maternal and infant health, reducing complications during pregnancy and at birth. The research was published in the prestigious New England Journal of Medicine.

Conducted through a randomized controlled trial spanning 17 hospitals in Australia, Austria, Sweden, and India, more than 43,000 pregnant women under 20 weeks were screened. Among them, 802 women diagnosed with gestational diabetes, according to WHO guidelines and at least one diabetes risk factor, were selected.

These women were randomly assigned to two groups: one received early treatment for gestational diabetes before 20 weeks, while the other followed standard treatment between 24 and 28 weeks based on a 75-gram oral glucose tolerance test (OGTT) as the control group. The trial assessed adverse outcomes for mothers, fetuses, and newborns.

Results showed that immediate treatment of gestational diabetes before the 20th week, especially before the 14th, improves outcomes such as reduced risk of preterm birth, traumatic delivery, large infants (macrosomia), neonatal shoulder dystocia, respiratory distress syndrome, and infant mortality.

Professor David Simmons from the School of Medicine at Western Sydney University, who led the study, highlighted a nearly 50% reduction in neonatal respiratory issues requiring oxygen and a 40% decrease in intensive neonatal care days. Moreover, severe perinatal damage and perineal injury decreased by over three-quarters.

Researchers concluded that this research offers new evidence for high-risk pregnant women regarding early screenings and treatment for gestational diabetes, beyond the typical 24-28 week interventions.

Routine gestational diabetes screenings occur during these weeks; however, high-risk women are often also tested early to avoid missing a type 2 diabetes diagnosis. If blood sugar levels are above normal but not yet type 2 diabetes, it suggests treatment, though data demonstrating such treatments’ effects on mother or child were lacking. "We have filled this significant knowledge gap, likely impacting millions of pregnancies annually," stated Professor Simmons.

Nevertheless, the research team advocates for further confirmatory trials and long-term follow-up studies to precisely identify glycemic targets in gestational diabetes treatment, to understand if even women without risk factors can benefit from early intervention.

This important study demonstrated that in pregnant women with elevated early pregnancy blood sugar levels or at risk of developing gestational diabetes, starting treatment before the 20th week significantly reduced a range of pregnancy complications compared to beginning treatment after a gestational diabetes diagnosis at 24 to 28 weeks, which is the current standard.

To support a healthy pregnancy, early adherence to key principles is essential: a personalized nutrition plan with a dietitian to ensure proper carbohydrate distribution, regular blood sugar monitoring, ideally using continuous glucose monitors to track real time levels and the effects of meals, and consistent prenatal follow up. Additionally, limiting processed foods, increasing fiber intake, regular exercise, and maintaining adequate hydration under the guidance of healthcare providers are strongly recommended.

Dr. Mariana Yaron is an expert in internal medicine and endocrinology at the DMC Diabetes Treatment Center and the Institute of Endocrinology, Metabolism, and Hypertension at Tel Aviv Sourasky Medical Center (Ichilov).