In a landmark study, immediate treatment before 20 weeks' gestation resulted in a modestly lower occurrence of adverse neonatal outcomes compared to deferred treatment. The study, which randomly assigned women with a risk factor for hyperglycemia, aimed to determine whether early intervention could improve maternal and infant health outcomes. The trial encompassed 802 females (between 4 weeks’ and 19 weeks 6 days’ gestation), with 406 receiving immediate therapy and 396 forming the control group (receiving deferred or no therapy).

The study assessed three main outcomes: a combination of negative neonatal events (such as birth before <37 weeks, birth trauma, birth weight of ≥4500 g, respiratory distress, shoulder dystocia, phototherapy, stillbirth or neonatal death), pregnancy-related hypertension (including  gestational hypertension, preeclampsia, or eclampsia), and lean body mass of neonates. Initial oral glucose-tolerance tests (OGTT) were conducted at a mean gestation of 15.6 ±2.5 weeks.
 

The key findings were:

1. Adverse Outcomes for Neonates:

• Notably, 94 of 378 females (24.9%) in the immediate-treatment group experienced adverse neonatal outcomes.
• In the control group, 113 of 370 females (30.5%) faced adverse outcomes.
• The adjusted risk difference was -5.6 percentage points; 95% confidence interval [CI], -10.1 to -1.2.

2. Pregnancy-Related Hypertension:

• As found, 40 of 378 females (10.6%) in the immediate-treatment group developed pregnancy-related hypertension.
• In the control group, 37 of 372 women (9.9%) experienced hypertension.
• The adjusted risk difference was reported to be 0.7 percentage points; 95% CI, -1.6 to 2.9.

3. Lean Body Mass of Neonates:

• The mean lean body mass for neonates was 2.86 kg in the immediate-treatment group vs 2.91 kg in the control group.
• The adjusted mean difference was -0.04 kg; 95% CI, -0.09 to 0.02.

There were no discernible variations between the groups concerning significant adverse events correlated with screening and management. Hence, prompt management of gestational diabetes prior to 20 weeks gestation was associated with a modestly diminished risk of adverse neonatal outcomes compared to no immediate treatment. However, no profound differences were observed in pregnancy-connected hypertension or infant lean body mass between the two groups. This research sheds light on the potential benefits of early intervention in gestational diabetes, offering valuable insights for healthcare practitioners and expectant mothers.