A Randomized controlled trial comparing two antenatal care regimes in the management of mild to moderate gestational diabetes in low middle income countries

Abstract

Abstract Objective The aim of the study is to see if single ultrasound scan in the early third trimester could identify women who need frequent visits for strict glycemic control and the impact on neonatal and maternal outcomes in clinical practice.We decided not to look at serial ultrasounds to detect accelerated growth as it would be expensive, time consuming and difficult to replicate in normal practice. Methods The study was a randomized controlled trial, conducted at Christian Medical College and Hospital(CMCH), a tertiary hospital in south India. The study population was recruited from women who visited antenatal outpatient clinic in the department of Obstetrics and Gynaecology, CMCH, Vellore between May 2019 to September 2021 Results 588 women were included in the study. Outcomes between conventional and ultrasound subgroups ( Standard + ultrasound subgroup with AC ≤ 70 th centile vs ultrasound subgroup AC ≥ 70 th centile)showed significant difference in outcomes.Ultrasound subgroup with AC ≥ 70 th centile had macrosomia(3.59% vs26.67%, P < 0.001),increased severity of diabetes(2.97% vs 16.67%, P < 0.001), 3 rd and 4 th degree perineal tear(2.95% vs 27.27%, P < 0.001) . Conclusion Thus in conclusion this small well designed study did not show any advantage with USGR as compared to the pragmatic simple standard regime, in treatment of women with GDM.