Management of gestational diabetes with a conservative insulin protocol

Objective: To investigate whether 2-hour postprandial blood glucose levels up to 8.0 mmol/L affect maternal or neonatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). Design: Retrospective analysis of data collated by the Victorian Perinatal Data Collection Unit. Patients: 394 GDM women and 394 control women matched for age and country of birth who gave birth at a university teaching hospital, 1991-1997. Main outcome measures: Maternal - hypertension/pre-eclampsia, obstetric intervention, gestation at delivery, length of hospital stay; neonatal - Apgar scores, time to establish respiration, birthweight, macrosomia, large or small for gestational age (LGA or SGA), fetopelvic disproportion, jaundice, hypoglycaemia. Results: For most outcome measures there were no statistically significant differences between the GDM and control groups. However, in the GDM group, gestation was shorter, hospital stays longer and delivery interventions more common. Conclusion: Our study suggests that maternal and neonatal outcomes in GDM women are comparable with those of women without GDM when 2-hour postprandial glucose levels of up to 8 mmol/L are maintained. This is 1.0 mmol/L higher than the current Australian Diabetes in Pregnancy Society recommendation.