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Re: GDM screening- commentFrom: Ira Mark Bernstein (ibernste@zoo.uvm.edu)Thu Jan 30 07:31:45 1997
I would tend to agree with Malcolm's comments with one exception. Insulin therapy has been demonstrated to reduce birth weight among women with GDM. This reduction in birth weight, however, has not been associated with any improvement in outcome. This is all reported in the Cochrane data base. Personally, I believe that GDM is associated with adverse outcomes and that there is no compelling data demonstrating improvement in clinical outcome associated with a specific course of therapy. Nevertheless I do treat GDM aggressively with the goal of normalizing glycemic state. One could draw an interesting analogy to the management of diabetes outside pregnancy where the long term complications of diabetes were only recently conclusively linked to glycemic state. (DCCT trials NEJM). I would be curious if these same non-obstetricians used only enough insulin to prevent ketoacidosis in their diabetic subjects prior to the DCCT trial report.
But restricting carbohydrate, testing blood sugars and/or
>injecting Insulin don't help at all. The Cochrane database is quite IRA
-- Ira M. Bernstein M.D. Department of OB\GYN University of Vermont (802) 656-5111 (ph) ibernste@zoo.uvm.edu
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