Early treatment of gestational diabetes and obstetric adverseoutcome prevention

Objectives: The newly proposed criteria for diagnosing gestational diabetes are based primarily on the levels of glucose associated with a 1.75-fold increased risk of having pregnancy adverse outcome related to gestational diabetes in the Hyperglycemia Adverse Pregnancy Outcome (HAPO) Study. Early detection of gestational diabetes due to elevated random fasting glucose level is suitable to longer period of glucose monitoring and dietary therapy. Inositol supplementation has been described as in vitro and in vivo benefit by diminishing the rate of embryonic dysmorphogenesis due to high glucose concentration and diabetes. Methods: We enrolled 28 pregnant women presenting a random fasting glucose above 92 mg% (5.0 mmol/dL). This case-control study was randomized by age, parity, risk factors, and pregestational BMI. 14 women were exposed to myo-inositol 4000 mg daily in case group, and the control group was exposed to folic acid 400 mcg daily. Dietary intake was limited to 1800 Kcal daily, and women were invited to moderate physical activities (20 minutes of walk daily) either in case and in control group. Results: The major findings were evaluation of OGTT (75 grms of glucose) at 24–27 wks, increase of BMI at the time of OGTT, fetal abdominal circumference and polyhydramnios during third trimester. Neonatal outcome such as fetal weight, route of delivery, and neonatal hypoglycemia, were recorded. Our study demonstrated that inositol exposure reduce significantly the incidence of altered OGTT (P < 0.0001). Furthermore during the third trimester the control group presented evidences of pour glycemic control represented as higher abdominal circumference centile and higher incidence of polyhydramnios whereas inositol exposed fetuses were not. Conclusions: The newly proposed criteria for diagnosing gestational diabetes will result in an earlier detection of affected pregnant women, and the correct management is represented by better reduction of hyperglycemia side effect particularly during third trimester of pregnancy either with diet control and dietary inositol intake.