011. GESTATIONAL DIABETES – COMPLICATIONS, MANAGEMENT, OUTCOMES

Abstract

Gestational diabetes (GDM) is associated with increased maternal risks of hypertensive complications, caesarean section and later diabetes. The fetus is exposed to an excess nutrient load and risks of macrosomia, trauma at delivery, neonatal complications and later obesity and associated metabolic consequences. Perinatal outcomes are improved by treating GDM, but the effect on longer term outcomes is not clear. Can we improve pregnancy and later outcomes further by considering choice of medication and treatment targets? The metformin in gestational diabetes (MiG) trial demonstrated that pregnancy outcomes were not different between women randomized to metformin compared to insulin. A composite of neonatal complications was seen in 32.0% and 32.2% respectively, RR 0.99 (95% CI 0.80–1.23). Examining glucose control during treatment in tertiles, women who achieved a mean fasting capillary glucose level <4.9 mmol/L had the lowest risk of neonatal complications. Those achieving a postprandial capillary glucose mean <6.5mmol/L had lower rates of preeclampsia and birth weight >90th centile. Obesity was not a significant factor predicting outcomes (unlike diet-alone treated women). Preliminary analyses from the follow up of two year old children from the MiG trial, the offspring follow up (TOFU) show body composition, diet and activity assessments are similar, with small differences between the metformin and insulin groups, respectively in biceps (6.1 vs 5.6 mm P = 0.04) and subscapular skin folds (6.38 vs 6.10 mm P = 0.03) and upper arm circumference (17.3 vs 16.7 cm P = 0.003). Ratios of central to peripheral fat as measured by waist: hip circumference, suscapular : triceps skin folds and abdominal : thigh fat by DEXA were no different. Further analyses will be performed when the final data entries are completed and details of these will be presented.