Ultrasound-guided compared to conventional treatment in gestational diabetes leads to improved birthweight but more insulin treatment: systematic review and meta-analysis.

Abstract

OBJECTIVE:

To perform a systematic review and meta-analysis of randomized controlled trials assessing ultrasound-guided versus conventional management in women with a broad severity-spectrum of gestational diabetes mellitus.

DESIGN:

Systematic review and meta-analysis of trials published until August 2012.

SETTING:

PubMed and Web of Science databases.

STUDY SELECTION AND METHODS:

Eighteen studies were reviewed in full text. Eligibility criteria were (i) randomized controlled trials comparing metabolic management in women with gestational diabetes mellitus and ultrasound-based vs. the conventional management to assess fetal growth, (ii) representative of the whole spectrum of hyperglycemia and fetal growth, (iii) data on perinatal outcomes. Review Manager 5.0 was used to summarize the results.

RESULTS:

Two studies fulfilled inclusion criteria. The ultrasound-guided group had a lower rate of large-for-gestational age newborns (relative risk 0.58, 95% confidence interval 0.34-0.99), macrosomia (relative risk 0.32, 95% confidence interval 0.11-0.95) and abnormal birthweight (small/large-for-gestational age, relative risk 0.64, 95% confidence interval 0.45-0.93) and a higher rate of insulin treatment (relative risk 1.58, 95% confidence interval 1.14-2.20). The number of women with gestational diabetes with a need to treat to prevent an additional newborn with abnormal birthweight was 10.

CONCLUSIONS:

In women with a broad severity-spectrum of gestational diabetes mellitus, ultrasound-guided management improves birthweight distribution, but increases the need for insulin treatment. More research is needed in this area because results are derived from a limited number of patients.

• Authors: Montserrat Balsells, Apolonia García-Patterson, Ignasi Gich, Rosa Corcoy
• Journal: Acta obstetricia et gynecologica Scandinavica (Acta Obstet Gynecol Scand) Vol. 93 Issue 2 Pg. 144-51 (Feb 2014) ISSN: 1600-0412 [Electronic] United States
• PMID: 24372329 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Chemical References

• Insulin

Topics

• Birth Weight
• Diabetes, Gestational (diagnostic imaging, therapy)
• Female
• Fetal Development (physiology)
• Fetal Macrosomia (diagnostic imaging)
• Humans
• Insulin (therapeutic use)
• Practice Guidelines as Topic
• Pregnancy
• Severity of Illness Index
• Ultrasonography, Prenatal