Early control of blood sugar is key to gestational diabetes

According to a new study by Kaiser Permanente, pregnant women who are treated for gestational diabetes have better
results in childbirth if their blood sugar levels improve rapidly immediately after diagnosis, rather than slowly or without improvement.

The study, published Sept.
29 in the American Medical Association Journal JAMA Network Open, found that patients with slower improvements or no optimal blood sugar control had a higher
risk of having a caesarean section, gestational-age older infants, shoulder dislocation during delivery, or admission to a neonatal intensive care unit.

"Blood glucose control is the cornerstone of gestational diabetes management, so it's important to have a detailed understanding of the control trajectory between diagnosis and childbirth," said
Yeyi Zhu, a research scientist and senior author in Kaiser Permanente's research department.
"This study not only determines whether a patient has blood sugar control, but also provides insights into
the role of blood glucose control timing.
"

The study also elucidated factors that enable patients to control blood glucose levels early: maintaining a healthy weight before pregnancy, avoiding smoking and alcohol during pregnancy, participating in gestational diabetes care programs, closely self-monitoring blood glucose levels, and patients were asked to do so 4 times
a day.

All of the patients studied joined Kaiser Perpetual Northern California Regional Perinatal Services (RPSC), a telehealth program
for people with gestational diabetes.
The program provides standardized telephone counseling on diet, physical activity, blood glucose monitoring, and medications to lower blood sugar
.

Dr Rana Chehab, a researcher in the research department, said: "One of the things that patients with early blood glucose control are more likely to participate in RPSC is that they are more likely to participate in RPSC
.
" "They are more likely to call a nurse and measure glucose
at least 3 times a day.
"

The authors say it's
important that nearly 90 percent of patients who participate in telemedicine support programs have significantly improved their blood sugar levels before delivery.

Mara Greenberg, MD, co-author of the study, said: "Managing a person's blood glucose during pregnancy can be difficult, and we provide personalized care for our patients, delivered
by very knowledgeable and caring staff.
" Mara Greenberg, MD, is a maternal-fetal medicine specialist at Perpetual Medical Group, directing regional perinatal service centers
.
"This study shows that most of our patients get good results, and we're very proud of
that.
"

Four trajectories controlled by glucose

Kaiser Permanente routinely screened pregnant women in Northern California for gestational diabetes at the end of the second trimester, and during the study period, in accordance with national standards, screening of patients at high risk for gestational diabetes in the first trimester of pregnancy
.
Gestational diabetes increases the risk of complications for both mother and child, including pre-eclampsia, preterm birth and babies who are too old to gestational, as well as long-term metabolic and cardiovascular problems
.

The study included 26,774 people
enrolled in the gestational diabetes program at Kaiser Permanente, Northern California, between January 2007 and December 2017.
The researchers analyzed data on blood glucose control levels from diagnosis to childbirth and found that patients were divided into 4 different trajectories
.
About 40% are "stable best", with good control at the beginning and maintained
.
About 34 percent "improved quickly to the optimal level," and the trajectory showed rapid improvement to the optimal level
.
When the indicators recommended by the American Diabetes Association are met, glucose control is labeled as "
optimal.
"

In the third category, "slow improvement to near optimum", 15% of patients improved slowly
after diagnosis of gestational diabetes until delivery.
The fourth, 11 percent, "slowly improved to sub-optimal," improved slowly over time, not reaching optimal levels
before delivery.

Assiamira Ferrara, M.
D.
, co-author of the study, research scientist and associate director of the research department, said the study adds important details
to the experience of managing gestational diabetes.
"Previous studies have divided women into two categories: controlling blood sugar or not controlling blood sugar, but we wanted to know if the time to achieve blood sugar control is related to the outcome, and the results are indeed so
," she said.

Future studies could compare patients with different trajectories to understand how they differed
.
Dr.
Greenberg said: "Some patients can control blood sugar relatively quickly and maintain this level, while others have difficulty controlling it, and we don't always know why
.
"