OBJECTIVE: To perform a systematic review and meta-analysis of randomized controlled trials assessing ultrasound-guided versus conventional management in women with a broad severity-spectrum of gestational diabetes mellitus. DESIGN: Systematic review and meta-analysis of trials published until August 2012. SETTING: PubMed and Web of Science databases. STUDY SELECTION AND METHODS: Eighteen studies were reviewed in full text. Eligibility criteria were (i) randomized controlled trials comparing metabolic management in women with gestational diabetes mellitus and ultrasound-based vs. the conventional management to assess fetal growth, (ii) representative of the whole spectrum of hyperglycemia and fetal growth, (iii) data on perinatal outcomes. Review Manager 5.0 was used to summarize the results. RESULTS: Two studies fulfilled inclusion criteria. The ultrasound-guided group had a lower rate of large-for-gestational age newborns (relative risk 0.58, 95% confidence interval 0.34-0.99), macrosomia (relative risk 0.32, 95% confidence interval 0.11-0.95) and abnormal birthweight (small/large-for-gestational age, relative risk 0.64, 95% confidence interval 0.45-0.93) and a higher rate of insulin treatment (relative risk 1.58, 95% confidence interval 1.14-2.20). The number of women with gestational diabetes with a need to treat to prevent an additional newborn with abnormal birthweight was 10. CONCLUSIONS: In women with a broad severity-spectrum of gestational diabetes mellitus, ultrasound-guided management improves birthweight distribution, but increases the need for insulin treatment. More research is needed in this area because results are derived from a limited number of patients.
OBJECTIVE: To perform a systematic review and meta-analysis of randomized controlled trials assessing ultrasound-guided versus conventional management in women with a broad severity-spectrum of gestational diabetes mellitus. DESIGN: Systematic review and meta-analysis of trials published until August 2012. SETTING: PubMed and Web of Science databases. STUDY SELECTION AND METHODS: Eighteen studies were reviewed in full text. Eligibility criteria were (i) randomized controlled trials comparing metabolic management in women with gestational diabetes mellitus and ultrasound-based vs. the conventional management to assess fetal growth, (ii) representative of the whole spectrum of hyperglycemia and fetal growth, (iii) data on perinatal outcomes. Review Manager 5.0 was used to summarize the results. RESULTS: Two studies fulfilled inclusion criteria. The ultrasound-guided group had a lower rate of large-for-gestational age newborns (relative risk 0.58, 95% confidence interval 0.34-0.99), macrosomia (relative risk 0.32, 95% confidence interval 0.11-0.95) and abnormal birthweight (small/large-for-gestational age, relative risk 0.64, 95% confidence interval 0.45-0.93) and a higher rate of insulin treatment (relative risk 1.58, 95% confidence interval 1.14-2.20). The number of women with gestational diabetes with a need to treat to prevent an additional newborn with abnormal birthweight was 10. CONCLUSIONS: In women with a broad severity-spectrum of gestational diabetes mellitus, ultrasound-guided management improves birthweight distribution, but increases the need for insulin treatment. More research is needed in this area because results are derived from a limited number of patients.
Authors: Deborah J Wexler; Camille E Powe; Linda A Barbour; Thomas Buchanan; Donald R Coustan; Rosa Corcoy; Peter Damm; Fidelma Dunne; Denice S Feig; Assiamira Ferrara; Lorie M Harper; Mark B Landon; Sara J Meltzer; Boyd E Metzger; Hilary Roeder; Janet A Rowan; David A Sacks; David Simmons; Jason G Umans; Patrick M Catalano Journal: Obstet Gynecol Date: 2018-08 Impact factor: 7.661
Authors: Lucy Mackillop; Jane Elizabeth Hirst; Katy Jane Bartlett; Jacqueline Susan Birks; Lei Clifton; Andrew J Farmer; Oliver Gibson; Yvonne Kenworthy; Jonathan Cummings Levy; Lise Loerup; Oliver Rivero-Arias; Wai-Kit Ming; Carmelo Velardo; Lionel Tarassenko Journal: JMIR Mhealth Uhealth Date: 2018-03-20 Impact factor: 4.773