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A Large Study Of Aotearoa New Zealand’s Shift To
Tighter Control Of Gestational Diabetes Finds Improved
Outcomes For Newborns
Babies’ birth injuries and
deaths have been reduced with the introduction of stricter
diabetes controls across hospitals in Aotearoa New Zealand,
new University of Auckland research finds.
Women with
gestational diabetes can change their diet and take
medication, if needed, to control their blood sugar levels,
but it has been unclear how tightly those levels should be
controlled to minimise the risks to the mother and
baby.
The Liggins Institute-led researchers studied
pregnant women with gestational diabetes as the new tighter
targets for blood sugar were introduced following Ministry
of Health recommendations in 2014.
They compared more
than 500 women where the older, less tight blood sugar
targets were applied and a similar number with the new
tighter targets. See PLOS
Medicine (8 September 2022).
“We expected to see
fewer large babies and did not, but we saw benefits for
babies, including a reduction in serious health problems
that included deaths,” says lead researcher Professor
Caroline Crowther.
However, to the researchers’
surprise, the tighter blood-sugar control increased the risk
of serious health outcomes for the mother, although these
events were rare.
“Individual health problems
weren’t statistically significant but, as a composite they
were,” Crowther says. “The largest contributor was major
haemorrhage, which is not known to be linked to gestational
diabetes. These findings remain
unexplained.”
Further research is needed in a
variety of healthcare settings, Crowther says.
The
Liggins-led group plans to follow-up the mothers and babies
four years’ after the birth. They will assess the
metabolic health of the mothers and the size of the
children, as well as incidence of obesity and diabetes,
which are associated with gestational
diabetes.
Liggins researchers estimate over six
percent of New Zealand women or about 3,800 per year develop
diabetes during pregnancy, with Māori, Pacific and Asian
women over-represented.
This study follows publication
of another trial, also led by Crowther, comparing diagnostic
thresholds for gestational diabetes, which supported
diagnosis at a lower blood sugar level than currently
recommended in New Zealand. This was associated with a
greater number of interventions, but better outcomes for
mothers and babies when mild disease was detected and
treated. See New
England Journal of Medicine 18 August 2022.
Both
studies responded to research questions posed by the New
Zealand Ministry of Health following the guidelines review
in 2014.
Liggins director Professor Frank Bloomfield
says, “The Liggins Institute, which celebrates its 21st
anniversary this year, is well set up to conduct these large
trials that inform healthcare internationally. These trials
will provide valuable information for updating the national
gestational diabetes guidelines.”
© Scoop Media
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