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

A groundbreaking study explored whether treating gestational diabetes before the 20th week of pregnancy among expectant mothers with risk factors for diabetes improves both maternal and infant health, reducing pregnancy and birth complications. This 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 divided into two groups: one receiving early gestational diabetes treatment before 20 weeks, and the other receiving standard treatment between 24-28 weeks based on a 75-gram glucose tolerance test (OGTT) (control group). The study evaluated adverse outcomes for the mother, fetus, and newborn.

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 concludedthat 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 showed that in pregnant women with abnormal early pregnancy blood sugar levels and/or those at risk of developing gestational diabetes, early treatment before the 20th week significantly reduced a range of pregnancy complications compared to starting treatment post gestational diabetes diagnosis at 24-28 weeks, as is common now. Adhering to the following principles early in pregnancy could promote a healthy pregnancy: a personalized nutritional plan with a dietitian for proper carbohydrate distribution in meals, constant blood sugar monitoring using continuous glucose monitors, if possible, to reflect real-time sugar levels and the food’s impact on them, and regular pregnancy follow-up. Additionally, avoiding processed and industrial food, increasing fiber intake, exercising most days of the week, and adequate water intake as advised by healthcare providers are 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 Sourasky Medical Center Ichilov Tel Aviv.