Babies Healthier if Diabetic Moms Treated

June 13 , 2005
By ALICIA CHANG

SAN DIEGO (AP) - Women who develop diabetes during pregnancy give birth to healthier babies if they are aggressively treated, concludes a large new study that helps bolster the case for testing all pregnant women for this condition.

The study, by Australian researchers, is the first to show that treatment can help avoid serious problems at birth.

Although complications are uncommon, they were four times lower among babies of mothers who were aggressively treated. No babies born to the 490 women getting more aggressive care died. There were three stillbirths and two other infant deaths among the 510 mothers who got regular care.

Results of the study will be published in the New England Journal of Medicine on Thursday and were presented Sunday at an American Diabetes Association meeting.

Gestational diabetes sometimes begins or is diagnosed in mid-pregnancy and disappears later. Women who get it have a greater chance of having diabetes in the future. Doctors don't know if there's a risk to babies.

It affects 3 percent to 7 percent of pregnant women in the United States, a number that is on the rise because of the growing obesity problem.

Doctors have long wrangled over whether babies would benefit if expectant mothers were tested and treated for the problem, and previous studies have had conflicting conclusions.

The American College of Obstetricians and Gynecologists backs diabetes screening for all pregnant women. The U.S. Preventive Services Task Force, a federal panel that makes recommendations on health issues, has not taken a stand, citing weak evidence.

The task force's Dr. Diana Petitti declined to comment specifically on the Australian study, but said the group always considers the latest research in deciding whether to update guidelines.

In an accompanying editorial, Dr. Michael Greene, an obstetrician at Massachusetts General Hospital who had no role in the study, wrote that the latest study "provides some long-awaited evidence to support the use of screening and treatment for women at risk."

In the study, researchers followed 1,000 women with gestational diabetes. During their third trimester, the women were separated into two groups: One group aggressively managed their diabetes through special diet, blood sugar monitoring and insulin therapy. The other had typical prenatal care.

Four percent of babies whose mothers received routine care developed complications - such as shoulder damage, bone fracture, nerve problems or death - compared to 1 percent of babies whose mothers received aggressive care.

Women who tightly controlled their diabetes were less likely to deliver extremely large babies weighing more than 8 pounds - 21 percent of babies whose mothers were regularly treated were oversized compared to 10 percent in the other group.

Researchers also compared depression and mood in 573 mothers three months after delivery and found that women who were rigorously treated fared better.

Another study presented at the meeting found that Type 1 diabetics who closely watched their blood sugar levels dramatically cut their risk of heart disease even if they relaxed their control later on. Type 1 diabetics make up 5 percent to 10 percent of the 18 million Americans who have the disease.

Heart disease is the leading cause of diabetes-related deaths, and diabetics are more than twice as likely to die from it than non-diabetics.

Researchers followed 1,375 people from the 1980s. For 6 1/2 years, one group managed diabetes aggressively, getting insulin at least three times a day. The other group got regular treatment and only one or two shots of insulin a day.

During the next decade, all controlled blood sugar. Most who got regular treatment adopted stricter blood sugar control while the intensive group became lax. The result was that the blood sugar levels in both groups evened out.

However, only 4 percent of people treated intensively in the early years had a heart problem during the following decade compared to 7 percent of those initially given regular care. There were a total 46 heart attacks or similar problems in the intensive care group compared to 98 in the other group.

"If you control your diabetes well from the get-go, even if you let things slip later on, you still reap the benefit from those early formative years of intensive management," said Dr. Martin Abrahamson of the Joslin Diabetes Center in Boston. He was not part of the study.

"People should try to do intensive therapy as early as possible for as long as possible," said Dr. David Nathan, director of the Diabetes Center at Massachusetts General Hospital who co-chaired the study. It was funded by the National Institutes of Health and Genentech Inc. ( DNA ), which makes several diabetes drugs.

Also at the meeting, researchers led by Dr. Andre Scheen of the University of Liege in Belgium reported that an experimental pill that attacks obesity by blocking a pleasure center in the brain reduced blood sugar levels in people with Type 2 diabetes, the type linked to obesity.

It was the first test of the French company Sanofi-Aventis drug rimonabant in diabetics. After a year, out of the 1,045 participants, 43 percent who got the drug had normal blood sugar levels compared to 21 percent in the control group. The drug has previously shown promise as a way to control both weight and smoking.

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