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 R. 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, G. 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

*Corresponding author for this work

Research output: Contribution to journalArticle

9 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
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 R. ; 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, 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, 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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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.",
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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 Saade, {George R.} 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 G. 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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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, GR, 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

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 R.; 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, 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, 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

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 R.

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, G.

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

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

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 -