Treatment With Diet and Exercise for Women With Gestational Diabetes Mellitus Diagnosed Using IADPSG Criteria

Oratile Kgosidialwa, Aoife M Egan, Louise Carmody, Breda Kirwan, Patricia Gunning, Fidelma P Dunne

Prevalence of gestational diabetes mellitus (GDM) and obesity continue to increase. To ascertain if diet and exercise is a successful intervention for women with GDM and if a subset of these women have comparable outcomes to those with normal glucose tolerance (NGT). A retrospective cohort study. Five antenatal centers along the Irish Atlantic seaboard. 567 women diagnosed with GDM and 2499 women with NGT during pregnancy. Diet and exercise therapy on diagnosis of GDM. Multiple maternal and neonatal outcomes were examined. Infants of women with GDM were more likely to be hypoglycemic (OR 7.25 95%CI 2.94-17.9) at birth. They were more likely to be admitted to NICU (Neonatal Intensive Care Unit) (OR 2.16 95%CI 1.60-2.91). Macrosomia and large for gestational age (LGA) rates were lower in the GDM group (OR 0.48 95% 0.37-0.64 and OR 0.61 95% CI 0.46-0.82 respectively). There was no increase in small for gestational age (SGA) among offspring of women with GDM (OR 0.81 95%CI 0.49-1.34). Women with diet treated GDM and BMI<25kg/m(2) had similar outcomes to those with NGT of the same BMI group. Obesity increased risk for poor pregnancy outcomes regardless of diabetes status. MNT and exercise for women with GDM may be successful in lowering rates of LGA and macrosomia without increasing SGA rates. Women with GDM and a BMI <25kg/m(2) had outcomes similar to those with NGT suggesting that these women could potentially be treated in a less resource intensive setting.