Impact of different glycaemic treatment targets on pregnancy outcomes in gestational diabetes
Open accessAbstract
Aim: With no current randomized trials, we explored the impact of tight compared with standard treatment targets on pregnancy outcomes in gestational diabetes mellitus (GDM). Methods: This cohort study of singleton births ≥ 28 weeks’ gestation was conducted at two major Australian maternity services (2009–2013). Standardized maternal, neonatal and birth outcomes were examined using routine healthcare data and compared for women with GDM at Service One (n = 2885) and Service Two (n = 1887). Services applied different treatment targets: Service One (standard targets, reference group) fasting < 5.5 mmol/l, 2‐h postprandial < 7.0 mmol/l; Service Two (tight targets) fasting < 5.0 mmol/l, 2‐h postprandial < 6.7 mmol/l. Multivariable regression with propensity score adjustment was used to examine associations between targets and outcomes. Results: GDM prevalence and insulin use were 7.9% and 31% at Service One, and 5.7% and 46% at Service Two. There were no differences in primary outcomes: birthweight > 90th centile [adjusted odds ratio (OR) 1.06, 95% confidence interval (CI) 0.87–1.30] and < 10th centile (OR 0.84, 95% CI 0.70–1.01), or secondary outcomes gestational hypertension, pre‐eclampsia, shoulder dystocia or a perinatal composite. Service Two with tight targets had increased induction of labour (OR 3.63, 95% CI 3.17–4.16), elective Caesarean section (OR 1.75, 95% CI 1.37–2.23) and Apgar scores < 7 at 5 min (OR 1.54, 95% CI 1.05–2.25), decreased hypoglycaemia (OR 0.76, 95% CI 0.61–0.94]), jaundice (OR 0.47, 95% CI 0.35–0.63) and respiratory distress (OR 0.68, 95% CI 0.47–0.98). Conclusions: Tight GDM treatment targets were associated with greater insulin use and no difference in primary birthweight outcomes. The service with tight targets had higher obstetric intervention, lower rates of reported hypoglycaemia, jaundice, respiratory distress and lower Apgar scores. High‐quality interventional data are required before tight treatment targets can be implemented.
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Tight glycemic control with A1C below 6.5% and without significant hypoglycemia will lower the risks of congenital malformations, preeclampsia, and perinatal mortality.
“The goals of preconception care should be tight glycemic control with an A1C <6.5%, without significant hypoglycemia, which will lower risks of congenital malformations, preeclampsia, and perinatal mortality.113”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [113]
The Primary and secondary outcomes section (page unavailable) reports no difference in pre-eclampsia or the composite perinatal outcome between tight and standard gestational-diabetes targets, contrary to the claimed reduction. The paper studies glucose targets during pregnancy, not preconception A1C below 6.5%, and does not establish a reduction in congenital malformations or perinatal mortality. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredElevated blood glucose at conception and in the early first trimester is associated with higher rates of congenital malformations, spontaneous abortion, intrauterine fetal demise, pre-eclampsia, preterm delivery, and perinatal mortality.
“Elevated BG levels at conception and during the early first trimester are associated with increased rates of congenital malformations, spontaneous abortion, intrauterine fetal demise, pre-eclampsia, preterm delivery, and perinatal mortality.110–114”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [113]
The Author Manuscript reports that pre-eclampsia increased with glycaemia in the MiG trial, supporting one outcome in the claim. The Introduction also describes a general relationship between maternal glucose and neonatal outcomes, but our copy does not establish an association specifically at conception or in the early first trimester, or support the full list of outcomes attributed to it. Page numbers are unavailable in our copy. (LLM, conf=0.84)
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Self-citation
- Authors
- Abell, S. K., Boyle, J. A., Earnest, A., England, P., Nankervis, A., Ranasinha, S., Soldatos, G., Wallace, E. M., Zoungas, S., & J Teede, H.
- Affiliations
- Monash Health (AU)
- Monash University (AU)
- Royal Women's Hospital (AU)
- Monash Centre for Health Research and Implementation School of Public Health and Preventive Medicine Monash University Melbourne Vic. Australia
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2018-09-03
- Volume
- 36
- Issue
- 2
- Pages
- 177-183
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W2885735878
- Cited by
- 20
- References
- 28
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 1
- FWCI
- 2.53
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- Stanford Maternal and Child Health Research Institute
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Keywords
- gestational diabetes mellitus, tight glycemic control, pregnancy outcomes, birth weight, labor induction, elective cesarean section, neonatal hypoglycemia, neonatal jaundice, neonatal respiratory distress, insulin use, perinatal outcomes, gestational hypertension, preeclampsia, shoulder dystocia
- MeSH terms
- Adult, Birth Weight, Blood Glucose, Female, Humans, Hypoglycemic Agents, Insulin, Pregnancy, Pregnancy Outcome, Prenatal Care, Prospective Studies, Diabetes, Gestational, Postprandial Period, Delivery, Obstetric
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