Randomized Trial Evaluating a Predominately Fetal Growth–Based Strategy to Guide Management of Gestational Diabetes in Caucasian Women
Response to Schaefer-Graf et al.
- From the Good Samaritan Hospital, Los Gates, California
- Address correspondence to Dr. John L. Kitzmiller, Good Samaritan Hospital, 105 Johnson Hollow, Los Gates, CA 95030. E-mail: kitz{at}batnet.com
The randomized trial of Schaefer-Graf et al. (1) evaluating a fetal growth–based strategy to guide the management of gestational diabetes mellitus (GDM) in Berlin requires comment. The authors used measurement of fetal abdominal circumference (AC) at 20–35 weeks’ gestation taken by only three ultrasonographers (physician investigators) to determine the need for insulin therapy (36 of 90 subjects) compared with self-monitored fasting blood glucose (>90 mg/dl) and 2-h postprandial blood glucose (>120 mg/dl) values obtained 2 days per week, which indicated the need for insulin treatment (27 of 97 subjects). The authors found that the ultrasound-based strategy provided outcomes (12% large for gestational age, 17% neonatal hypoglycemia, 14% transfer to the neonatal intensive care unit [NICU]) that were no …
