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KCE reports vol. 6A Prenatale zorg 176
Does screening for and instituting interventions for GDM result in improved maternal and perinatal outcomes?
Study Ref Population Intervention Outcomes Results Comments Study
Walkinshaw,
2000
Persson,
1985
4 [504] 4 RCTs (612 women
with impaired
glucose tolerance or
gestational diabetes
4 [505] 202 pregnant
women
with impaired
glucose tolerance
Diet therapy vs. no specific
treatment
Treatment by diet (n = 105)
vs. diet and insulin (n = 97)
(insulin doses adjusted
according to blood glucose
Maternal and fetal
complications
associated with
diabetes
Obstetric
complications
Fetal complications
Caesarean section (4 RCTs,
n=612): Peto OR 0.97 (95% CI
0.65 to 1.44)
Preterm birth (1 RCT, n =
158): Peto OR 0.57 (95% CI
0.10 to 3.36)
Birth weight > 4000 g (2 RCTs,
n = 457): Peto OR 0.78 (95%
CI 0.45 to 1.35)
Birth weight > 4500 g (2 RCTs,
n = 457): Peto OR 0.85 (95%
CI 0.28 to 2.56)
Birth trauma (2 RCTs, n = 457):
Peto OR 0.13 (95% CI 0.02 to
0.96)
Perinatal death: not estimable
Admission to NICU (1 RCT, n
= 126): Peto OR 0.55 (95% CI
0.16 to 1.90)
Maternal hypertensive disorder
(1 RCT, n = 126): Peto OR
0.66 (95% CI 0.11 to 3.93)
Proteinuria, hypertension, preeclampsia,
and polyhydramnios
not significantly different
No perinatal deaths. Birth
Insulin was instituted in
15/105 (14%) of women
whose control exceeded
7 mmol/l (fasting) or 9
EL
type
SR 1a
RCT 1b