The TOBOGM randomized trial, reported in the New England Journal of Medicine, found that treating gestational diabetes early in pregnancy without waiting for a repeat oral glucose tolerance test (OGTT) improved newborn outcomes.

The trial comprised 802 women with an average age of 32 who were seen at 17 hospitals in Australia, Austria, India, and Sweden. The quick treatment group was more likely to get insulin or metformin than the delayed treatment group. One-third of the early gestational diabetes patients did not have it on repeat OGTT in the second trimester. Following the first primary objective of newborn events, hierarchical analysis of the second primary endpoint revealed that early therapy had no effect (10.6% versus 9.9%, adjusted mean difference 0.7 percentage points, 95% CI 1.6 to 2.9). The third main, newborn lean body mass did not differ substantially across groups.

Serious adverse events related to screening and therapies were comparable across groups. Immediate treatment significantly decreased the composite incidence of unfavorable newborn outcomes (preterm delivery, birth trauma, high birth weight, respiratory distress, phototherapy) in women identified before 20 weeks gestation.

Furthermore, the risk of stillbirth, neonatal mortality, or shoulder dystocia was decreased to 24.9%, compared to 30.5% in those whose treatment was based on confirmation as usual after repeating the OGTT at 24 to 28 weeks gestation.

(Source: https://www.medpagetoday.com/obgyn/pregnancy/104373)