Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes

Anna Palatnik, Lisa Mele, Mark B. Landon, Uma M. Reddy, Susan M. Ramin, Marshall W. Carpenter, Ronald J. Wapner, Michael W. Varner, Dwight J. Rouse, John M. Thorp, Anthony Sciscione, Patrick Catalano, George Saade, Steve N. Caritis, Yoram Sorokin, A. Peaceman, P. Simon, G. Mallett, B. Casey, K. Leveno & 93 others L. Moseley, J. Gold, D. Bradford, L. Fay, M. Garcia, F. Capellan, M. Miodovnik, F. Malone, S. Bousleiman, H. Husami, V. Carmona, N. Fredericks, E. Gantioqui, B. Greenspan, M. Williams, K. Anderson, P. Ashby, S. McAllister, S. Quinn, F. Castinella, A. Guzman, J. Steiner, J. Parker, J. Sheppard, J. Tisdale, A. Northen, W. Andrews, D. Catlow, D. Allard, M. Seebeck, J. Tillinghast, J. Iams, F. Johnson, C. Latimer, E. Weinandy, B. Maselli, K. Dorman, S. Brody, S. Timlin, J. Bernhardt, M. Hoffman, E. Guzman, M. Talucci, T. Grossman, C. Perez, L. Zeghibe, P. Tabangin, B. Mercer, B. Stetzer, C. Milluzzi, W. Dalton, S. Pichette, M. Harper, M. Swain, P. Meis, J. White, L. Gilstrap, K. Cannon, J. Martinez, D. Dusek, J. Moss, J. Brandon, A. Jackson, Gary Hankins, D. Sharp, M. Bickus, H. Birkland, M. Cotroneo, N. Cuddy, G. Norman, P. Lockhart, S. Blackwell, L. Quast, A. Peaceman, P. Simon, G. Mallett, J. Tolosa, L. Davis, E. Lairson, C. Cromett, C. Naze, M. Blaser, E. Thom, J. Zachary, B. Getachew, C. Cobb, L. Leuchtenburg, S. Gilbert, T. Spangler, C. Spong, S. Tolivaisa, K. Howell, G. D. Anderson

    Research output: Contribution to journalArticle

    10 Citations (Scopus)

    Abstract

    Objective The purpose of this study was to examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes mellitus (GDM) and maternal and perinatal outcomes. Study Design We conducted a secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were assigned randomly to treatment vs usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal death. Other outcomes that were examined included the frequency of large for GA, birthweight, neonatal intensive care unit admission, gestational hypertension/preeclampsia, and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26, 27, 28, 29, and ≥30 weeks of gestation) and treatment group (treated vs routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences. Results Of 958 women whose cases were analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared with those who initiated treatment at a later GA (probability value for interaction with the primary outcome,.44). Similarly, there was no evidence that other outcomes were improved significantly by earlier initiation of GDM treatment (large for GA, P =.76; neonatal intensive care unit admission, P =.8; cesarean delivery, P =.82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (P =.04), although there was not a clear cut GA trend where this outcome improved with treatment. Conclusion Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes.

    Original languageEnglish (US)
    Pages (from-to)560.e1-560.e8
    JournalAmerican Journal of Obstetrics and Gynecology
    Volume213
    Issue number4
    DOIs
    StatePublished - Oct 1 2015

    Fingerprint

    Gestational Diabetes
    Gestational Age
    Therapeutics
    Pregnancy Induced Hypertension
    Neonatal Intensive Care Units
    Pre-Eclampsia
    Surrogate Mothers
    Neonatal Hyperbilirubinemia
    Hyperinsulinism
    Hypoglycemia

    Keywords

    • gestational age
    • gestational diabetes mellitus
    • outcome

    ASJC Scopus subject areas

    • Obstetrics and Gynecology

    Cite this

    Palatnik, A., Mele, L., Landon, M. B., Reddy, U. M., Ramin, S. M., Carpenter, M. W., ... Anderson, G. D. (2015). Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes. American Journal of Obstetrics and Gynecology, 213(4), 560.e1-560.e8. https://doi.org/10.1016/j.ajog.2015.06.022

    Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes. / Palatnik, Anna; Mele, Lisa; Landon, Mark B.; Reddy, Uma M.; Ramin, Susan M.; Carpenter, Marshall W.; Wapner, Ronald J.; Varner, Michael W.; Rouse, Dwight J.; Thorp, John M.; Sciscione, Anthony; Catalano, Patrick; Saade, George; Caritis, Steve N.; Sorokin, Yoram; Peaceman, A.; Simon, P.; Mallett, G.; Casey, B.; Leveno, K.; Moseley, L.; Gold, J.; Bradford, D.; Fay, L.; Garcia, M.; Capellan, F.; Miodovnik, M.; Malone, F.; Bousleiman, S.; Husami, H.; Carmona, V.; Fredericks, N.; Gantioqui, E.; Greenspan, B.; Williams, M.; Anderson, K.; Ashby, P.; McAllister, S.; Quinn, S.; Castinella, F.; Guzman, A.; Steiner, J.; Parker, J.; Sheppard, J.; Tisdale, J.; Northen, A.; Andrews, W.; Catlow, D.; Allard, D.; Seebeck, M.; Tillinghast, J.; Iams, J.; Johnson, F.; Latimer, C.; Weinandy, E.; Maselli, B.; Dorman, K.; Brody, S.; Timlin, S.; Bernhardt, J.; Hoffman, M.; Guzman, E.; Talucci, M.; Grossman, T.; Perez, C.; Zeghibe, L.; Tabangin, P.; Mercer, B.; Stetzer, B.; Milluzzi, C.; Dalton, W.; Pichette, S.; Harper, M.; Swain, M.; Meis, P.; White, J.; Gilstrap, L.; Cannon, K.; Martinez, J.; Dusek, D.; Moss, J.; Brandon, J.; Jackson, A.; Hankins, Gary; Sharp, D.; Bickus, M.; Birkland, H.; Cotroneo, M.; Cuddy, N.; Norman, G.; Lockhart, P.; Blackwell, S.; Quast, L.; Peaceman, A.; Simon, P.; Mallett, G.; Tolosa, J.; Davis, L.; Lairson, E.; Cromett, C.; Naze, C.; Blaser, M.; Thom, E.; Zachary, J.; Getachew, B.; Cobb, C.; Leuchtenburg, L.; Gilbert, S.; Spangler, T.; Spong, C.; Tolivaisa, S.; Howell, K.; Anderson, G. D.

    In: American Journal of Obstetrics and Gynecology, Vol. 213, No. 4, 01.10.2015, p. 560.e1-560.e8.

    Research output: Contribution to journalArticle

    Palatnik, A, Mele, L, Landon, MB, Reddy, UM, Ramin, SM, Carpenter, MW, Wapner, RJ, Varner, MW, Rouse, DJ, Thorp, JM, Sciscione, A, Catalano, P, Saade, G, Caritis, SN, Sorokin, Y, Peaceman, A, Simon, P, Mallett, G, Casey, B, Leveno, K, Moseley, L, Gold, J, Bradford, D, Fay, L, Garcia, M, Capellan, F, Miodovnik, M, Malone, F, Bousleiman, S, Husami, H, Carmona, V, Fredericks, N, Gantioqui, E, Greenspan, B, Williams, M, Anderson, K, Ashby, P, McAllister, S, Quinn, S, Castinella, F, Guzman, A, Steiner, J, Parker, J, Sheppard, J, Tisdale, J, Northen, A, Andrews, W, Catlow, D, Allard, D, Seebeck, M, Tillinghast, J, Iams, J, Johnson, F, Latimer, C, Weinandy, E, Maselli, B, Dorman, K, Brody, S, Timlin, S, Bernhardt, J, Hoffman, M, Guzman, E, Talucci, M, Grossman, T, Perez, C, Zeghibe, L, Tabangin, P, Mercer, B, Stetzer, B, Milluzzi, C, Dalton, W, Pichette, S, Harper, M, Swain, M, Meis, P, White, J, Gilstrap, L, Cannon, K, Martinez, J, Dusek, D, Moss, J, Brandon, J, Jackson, A, Hankins, G, Sharp, D, Bickus, M, Birkland, H, Cotroneo, M, Cuddy, N, Norman, G, Lockhart, P, Blackwell, S, Quast, L, Peaceman, A, Simon, P, Mallett, G, Tolosa, J, Davis, L, Lairson, E, Cromett, C, Naze, C, Blaser, M, Thom, E, Zachary, J, Getachew, B, Cobb, C, Leuchtenburg, L, Gilbert, S, Spangler, T, Spong, C, Tolivaisa, S, Howell, K & Anderson, GD 2015, 'Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes', American Journal of Obstetrics and Gynecology, vol. 213, no. 4, pp. 560.e1-560.e8. https://doi.org/10.1016/j.ajog.2015.06.022
    Palatnik, Anna ; Mele, Lisa ; Landon, Mark B. ; Reddy, Uma M. ; Ramin, Susan M. ; Carpenter, Marshall W. ; Wapner, Ronald J. ; Varner, Michael W. ; Rouse, Dwight J. ; Thorp, John M. ; Sciscione, Anthony ; Catalano, Patrick ; Saade, George ; Caritis, Steve N. ; Sorokin, Yoram ; Peaceman, A. ; Simon, P. ; Mallett, G. ; Casey, B. ; Leveno, K. ; Moseley, L. ; Gold, J. ; Bradford, D. ; Fay, L. ; Garcia, M. ; Capellan, F. ; Miodovnik, M. ; Malone, F. ; Bousleiman, S. ; Husami, H. ; Carmona, V. ; Fredericks, N. ; Gantioqui, E. ; Greenspan, B. ; Williams, M. ; Anderson, K. ; Ashby, P. ; McAllister, S. ; Quinn, S. ; Castinella, F. ; Guzman, A. ; Steiner, J. ; Parker, J. ; Sheppard, J. ; Tisdale, J. ; Northen, A. ; Andrews, W. ; Catlow, D. ; Allard, D. ; Seebeck, M. ; Tillinghast, J. ; Iams, J. ; Johnson, F. ; Latimer, C. ; Weinandy, E. ; Maselli, B. ; Dorman, K. ; Brody, S. ; Timlin, S. ; Bernhardt, J. ; Hoffman, M. ; Guzman, E. ; Talucci, M. ; Grossman, T. ; Perez, C. ; Zeghibe, L. ; Tabangin, P. ; Mercer, B. ; Stetzer, B. ; Milluzzi, C. ; Dalton, W. ; Pichette, S. ; Harper, M. ; Swain, M. ; Meis, P. ; White, J. ; Gilstrap, L. ; Cannon, K. ; Martinez, J. ; Dusek, D. ; Moss, J. ; Brandon, J. ; Jackson, A. ; Hankins, Gary ; Sharp, D. ; Bickus, M. ; Birkland, H. ; Cotroneo, M. ; Cuddy, N. ; Norman, G. ; Lockhart, P. ; Blackwell, S. ; Quast, L. ; Peaceman, A. ; Simon, P. ; Mallett, G. ; Tolosa, J. ; Davis, L. ; Lairson, E. ; Cromett, C. ; Naze, C. ; Blaser, M. ; Thom, E. ; Zachary, J. ; Getachew, B. ; Cobb, C. ; Leuchtenburg, L. ; Gilbert, S. ; Spangler, T. ; Spong, C. ; Tolivaisa, S. ; Howell, K. ; Anderson, G. D. / Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes. In: American Journal of Obstetrics and Gynecology. 2015 ; Vol. 213, No. 4. pp. 560.e1-560.e8.
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    title = "Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes",
    abstract = "Objective The purpose of this study was to examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes mellitus (GDM) and maternal and perinatal outcomes. Study Design We conducted a secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were assigned randomly to treatment vs usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal death. Other outcomes that were examined included the frequency of large for GA, birthweight, neonatal intensive care unit admission, gestational hypertension/preeclampsia, and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26, 27, 28, 29, and ≥30 weeks of gestation) and treatment group (treated vs routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences. Results Of 958 women whose cases were analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared with those who initiated treatment at a later GA (probability value for interaction with the primary outcome,.44). Similarly, there was no evidence that other outcomes were improved significantly by earlier initiation of GDM treatment (large for GA, P =.76; neonatal intensive care unit admission, P =.8; cesarean delivery, P =.82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (P =.04), although there was not a clear cut GA trend where this outcome improved with treatment. Conclusion Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes.",
    keywords = "gestational age, gestational diabetes mellitus, outcome",
    author = "Anna Palatnik and Lisa Mele and Landon, {Mark B.} and Reddy, {Uma M.} and Ramin, {Susan M.} and Carpenter, {Marshall W.} and Wapner, {Ronald J.} and Varner, {Michael W.} and Rouse, {Dwight J.} and Thorp, {John M.} and Anthony Sciscione and Patrick Catalano and George Saade and Caritis, {Steve N.} and Yoram Sorokin and A. Peaceman and P. Simon and G. Mallett and B. Casey and K. Leveno and L. Moseley and J. Gold and D. Bradford and L. Fay and M. Garcia and F. Capellan and M. Miodovnik and F. Malone and S. Bousleiman and H. Husami and V. Carmona and N. Fredericks and E. Gantioqui and B. Greenspan and M. Williams and K. Anderson and P. Ashby and S. McAllister and S. Quinn and F. Castinella and A. Guzman and J. Steiner and J. Parker and J. Sheppard and J. Tisdale and A. Northen and W. Andrews and D. Catlow and D. Allard and M. Seebeck and J. Tillinghast and J. Iams and F. Johnson and C. Latimer and E. Weinandy and B. Maselli and K. Dorman and S. Brody and S. Timlin and J. Bernhardt and M. Hoffman and E. Guzman and M. Talucci and T. Grossman and C. Perez and L. Zeghibe and P. Tabangin and B. Mercer and B. Stetzer and C. Milluzzi and W. Dalton and S. Pichette and M. Harper and M. Swain and P. Meis and J. White and L. Gilstrap and K. Cannon and J. Martinez and D. Dusek and J. Moss and J. Brandon and A. Jackson and Gary Hankins and D. Sharp and M. Bickus and H. Birkland and M. Cotroneo and N. Cuddy and G. Norman and P. Lockhart and S. Blackwell and L. Quast and A. Peaceman and P. Simon and G. Mallett and J. Tolosa and L. Davis and E. Lairson and C. Cromett and C. Naze and M. Blaser and E. Thom and J. Zachary and B. Getachew and C. Cobb and L. Leuchtenburg and S. Gilbert and T. Spangler and C. Spong and S. Tolivaisa and K. Howell and Anderson, {G. D.}",
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    TY - JOUR

    T1 - Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes

    AU - Palatnik, Anna

    AU - Mele, Lisa

    AU - Landon, Mark B.

    AU - Reddy, Uma M.

    AU - Ramin, Susan M.

    AU - Carpenter, Marshall W.

    AU - Wapner, Ronald J.

    AU - Varner, Michael W.

    AU - Rouse, Dwight J.

    AU - Thorp, John M.

    AU - Sciscione, Anthony

    AU - Catalano, Patrick

    AU - Saade, George

    AU - Caritis, Steve N.

    AU - Sorokin, Yoram

    AU - Peaceman, A.

    AU - Simon, P.

    AU - Mallett, G.

    AU - Casey, B.

    AU - Leveno, K.

    AU - Moseley, L.

    AU - Gold, J.

    AU - Bradford, D.

    AU - Fay, L.

    AU - Garcia, M.

    AU - Capellan, F.

    AU - Miodovnik, M.

    AU - Malone, F.

    AU - Bousleiman, S.

    AU - Husami, H.

    AU - Carmona, V.

    AU - Fredericks, N.

    AU - Gantioqui, E.

    AU - Greenspan, B.

    AU - Williams, M.

    AU - Anderson, K.

    AU - Ashby, P.

    AU - McAllister, S.

    AU - Quinn, S.

    AU - Castinella, F.

    AU - Guzman, A.

    AU - Steiner, J.

    AU - Parker, J.

    AU - Sheppard, J.

    AU - Tisdale, J.

    AU - Northen, A.

    AU - Andrews, W.

    AU - Catlow, D.

    AU - Allard, D.

    AU - Seebeck, M.

    AU - Tillinghast, J.

    AU - Iams, J.

    AU - Johnson, F.

    AU - Latimer, C.

    AU - Weinandy, E.

    AU - Maselli, B.

    AU - Dorman, K.

    AU - Brody, S.

    AU - Timlin, S.

    AU - Bernhardt, J.

    AU - Hoffman, M.

    AU - Guzman, E.

    AU - Talucci, M.

    AU - Grossman, T.

    AU - Perez, C.

    AU - Zeghibe, L.

    AU - Tabangin, P.

    AU - Mercer, B.

    AU - Stetzer, B.

    AU - Milluzzi, C.

    AU - Dalton, W.

    AU - Pichette, S.

    AU - Harper, M.

    AU - Swain, M.

    AU - Meis, P.

    AU - White, J.

    AU - Gilstrap, L.

    AU - Cannon, K.

    AU - Martinez, J.

    AU - Dusek, D.

    AU - Moss, J.

    AU - Brandon, J.

    AU - Jackson, A.

    AU - Hankins, Gary

    AU - Sharp, D.

    AU - Bickus, M.

    AU - Birkland, H.

    AU - Cotroneo, M.

    AU - Cuddy, N.

    AU - Norman, G.

    AU - Lockhart, P.

    AU - Blackwell, S.

    AU - Quast, L.

    AU - Peaceman, A.

    AU - Simon, P.

    AU - Mallett, G.

    AU - Tolosa, J.

    AU - Davis, L.

    AU - Lairson, E.

    AU - Cromett, C.

    AU - Naze, C.

    AU - Blaser, M.

    AU - Thom, E.

    AU - Zachary, J.

    AU - Getachew, B.

    AU - Cobb, C.

    AU - Leuchtenburg, L.

    AU - Gilbert, S.

    AU - Spangler, T.

    AU - Spong, C.

    AU - Tolivaisa, S.

    AU - Howell, K.

    AU - Anderson, G. D.

    PY - 2015/10/1

    Y1 - 2015/10/1

    N2 - Objective The purpose of this study was to examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes mellitus (GDM) and maternal and perinatal outcomes. Study Design We conducted a secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were assigned randomly to treatment vs usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal death. Other outcomes that were examined included the frequency of large for GA, birthweight, neonatal intensive care unit admission, gestational hypertension/preeclampsia, and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26, 27, 28, 29, and ≥30 weeks of gestation) and treatment group (treated vs routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences. Results Of 958 women whose cases were analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared with those who initiated treatment at a later GA (probability value for interaction with the primary outcome,.44). Similarly, there was no evidence that other outcomes were improved significantly by earlier initiation of GDM treatment (large for GA, P =.76; neonatal intensive care unit admission, P =.8; cesarean delivery, P =.82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (P =.04), although there was not a clear cut GA trend where this outcome improved with treatment. Conclusion Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes.

    AB - Objective The purpose of this study was to examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes mellitus (GDM) and maternal and perinatal outcomes. Study Design We conducted a secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were assigned randomly to treatment vs usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal death. Other outcomes that were examined included the frequency of large for GA, birthweight, neonatal intensive care unit admission, gestational hypertension/preeclampsia, and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26, 27, 28, 29, and ≥30 weeks of gestation) and treatment group (treated vs routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences. Results Of 958 women whose cases were analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared with those who initiated treatment at a later GA (probability value for interaction with the primary outcome,.44). Similarly, there was no evidence that other outcomes were improved significantly by earlier initiation of GDM treatment (large for GA, P =.76; neonatal intensive care unit admission, P =.8; cesarean delivery, P =.82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (P =.04), although there was not a clear cut GA trend where this outcome improved with treatment. Conclusion Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes.

    KW - gestational age

    KW - gestational diabetes mellitus

    KW - outcome

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    UR - http://www.scopus.com/inward/citedby.url?scp=84942297615&partnerID=8YFLogxK

    U2 - 10.1016/j.ajog.2015.06.022

    DO - 10.1016/j.ajog.2015.06.022

    M3 - Article

    VL - 213

    SP - 560.e1-560.e8

    JO - American Journal of Obstetrics and Gynecology

    JF - American Journal of Obstetrics and Gynecology

    SN - 0002-9378

    IS - 4

    ER -