What's new in the other general journals

Mild gestational diabetes should be treated

Clinicians have been waiting a long time for some decent evidence to help resolve the debate about whether to screen for and treat glucose intolerance during pregnancy. A large trial of 1000 women has found, 12 years after it began, that actively treating women with mild gestational diabetes reduces the risk of serious perinatal complications, including neonatal death, and may even prevent postnatal depression. Women with severe gestational diabetes were excluded from this trial, which compared active treatment (blood glucose monitoring, diet, and insulin if required) with no treatment.

Controversially, the 510 women in the control group were not told that they had gestational diabetes. Their care was designed to replicate the care given to women attending hospitals that do not screen. Four per cent of their babies had a serious perinatal problem defined as death, shoulder dystocia, bone fracture, or nerve palsy. The rate of serious perinatal problems among the treated women was only 1%, a significant difference that translates to one serious complication fewer for every 34 women treated (95% confidence interval 20 to 103) and supports arguments for screening all pregnant women for glucose intolerance. Untreated women were also more likely to have a large baby (21% v 10%, P < 0.001). Three months after delivery, treated women had lower depression scores and better health related quality of life than control women.

New England Journal of Medicine 2005;352: 2477-86

Mechanical reperfusion reduces infarct size in patients who present late after heart attack

We already know that thrombolytic drugs do not work more than 12 hours after a heart attack. Mechanical reperfusion could be a reasonable alternative, according to a recent trial in 365 patients who presented to hospital 12-48 hours after the start of their symptoms. The trial was too small to assess the impact of treatment on survival, but it did find that late presenters who were taken straight …