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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the relation between gestational diabetes mellitus (GDM) and macrosomia, neonatal morbidity, and childhood obesity. Also presented is data demonstrating that treatment of GDM improves short-term fetal and neonatal outcomes, but does not reduce obesity in offspring at the age of 4 to 5 years.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPregnancy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPregnancy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EMatthew W. Gillman, MD, Harvard Medical School, Boston, Massachusetts, USA, discussed the relation between gestational diabetes mellitus (GDM) and macrosomia, neonatal morbidity, and childhood obesity. He shared data demonstrating that treatment of GDM improves short-term fetal and neonatal outcomes, but does not reduce obesity in offspring at the age of 4 to 5 years.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAs the global pandemic of diabetes continues, increasing numbers of women of childbearing age are at risk for GDM and type 2 diabetes mellitus (T2DM). GDM may contribute to an intergenerational cycle of obesity and diabetes: A woman who enters pregnancy overweight or obese may gain excessive weight and retain more postpartum, leading to T2DM and cardiovascular disease (CVD) in the long term. Fetal growth and metabolism may also be altered, leading to child obesity.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDr. Gillman discussed two trials that addressed the value of glucose control in GDM, both of which randomized \u223c 1000 patients to therapy or observation. In the Australian Carbohydrate Intolerance Study in Pregnant Women [ACHOIS], the composite end point of serious perinatal outcomes included fetal death, bone fracture, shoulder dystocia, and nerve palsy [Crowther CA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2005]. In the study conducted within the Maternal\u2014Fetal Medicine Units (MFMU) Network, the composite end point was stillbirth or perinatal death and neonatal complications, including hyperbilirubinemia, neonatal hypoglycemia, and hyperinsulinemia [Landon MB et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2005].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn the ACHOIS study, there was a decrease in the main outcome measure of any serious perinatal complication with intervention (RR, 0.33; 95% CI, 0.14 to 0.75; p = .01). However, the MFMU study composite outcome was not significantly changed (p = .14). The incidence of large-for-gestational age (LGA) decreased significantly in both studies (p\u0026lt; .001), whereas shoulder dystocia was only significantly decreased in the MFMU study (p = .02). In both trials, maternal weight gain from diagnosis to term was significantly lower with intervention (mean 1.7 kg less in ACHOIS, p = .01; 2.2 kg less in the MFMU study, p\u0026lt; .001), yet birth injury and small-for-gestational age were not significantly changed.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe results of both trials indicated the benefits of treating mild to moderate GDM, in particular with respect to reduced incidences of macrosomia and LGA. Subsequent meta-analyses and reviews have also provided broad agreement on these benefits and risks, noted Dr. Gillman.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ESince GDM has been hypothesized to cause obesity in offspring, a longer-term follow-up study of a subset of children from the ACHOIS trial compared the effect of treatment for mild GDM with routine care on the body mass index (BMI) of children aged 4 to 5 years. The main outcome was age- and sex-specific BMI. Although treatment of GDM substantially reduced macrosomia (5.3% vs 21.9%), there was no reduction in their mean BMI at age 4 to 5 years (0.49 in treatment vs 0.41 in routine care) [Gillman MW et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EStudies so far have therefore shown that GDM treatment reduces serious fetal and neonatal outcomes in the short term but do not show similar benefits in the longer term. However, the long-term findings are based on only 1 study. Additionally, GDM may affect weight in early infancy and again in later childhood, but not in early childhood; thus, even longer-term follow-up studies are required to address this question, Dr. Gillman concluded.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/19\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp35p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}