Randomized Trial Evaluating a Predominately Fetal Growth–Based Strategy to Guide Management of Gestational Diabetes in Caucasian Women
Response to Kitzmiller
- Ute M. Schaefer-Graf, MD, PHD
- From the Department of Obstetrics, Vivantes Medical Center, Berlin, Germany
- Address correspondence to Dr. Schaefer-Graf, Vivantes Medical Center, Department of Obstetrics, Mariendorfer Weg 28, 12051 Berlin, Germany. E-mail: ute.schaefer-graf{at}vivantes.de
We truly understand the concerns raised by our study (1) investigating a mainly fetal growth–based management strategy of gestational diabetes mellitus (GDM), since our data questioned the maternal glycemia-based management that we have used for decades. We are grateful for the opportunity of discussion.
Kitzmiller (2) is right that two profiles per week may not be considered as intensified management and that we might have missed occasional events of hyperglycemia. The large-for-gestational-age (LGA) rate in the standard group might have been slightly lower with more insulin therapy. But then we would have ended up with a rate of LGA newborns lower than the normal 10%. The tight blood glucose treatment in the ultrasound group is part of the concept of ultrasound-based management that concentrates intensive intervention on fetuses at risk (3,4).
In contrast to most areas of medicine, …
