Glucose Targets in Pregnant Women With Diabetes: A Systematic Review and Meta-Analysis
Abstract
BACKGROUND: Glucose-lowering treatments are used during pregnancy to reduce the risk for complications in the mother and offspring, yet treatment targets have not been established. OBJECTIVE: Our objective was to appraise and summarize the available evidence regarding the association between different blood glucose targets during pregnancy and fetal and maternal outcomes. METHODS: We searched Medline, EMBASE, Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL through May 2011 for randomized trials and observational studies that enrolled women with diabetes during pregnancy and reported planned or achieved glucose targets. We used random-effects meta-regression models to estimate the odds ratio for the association of outcomes of interest and glucose targets. When possible, we adjusted for diabetes type, trimester, and diabetes treatment. RESULTS: We included 34 studies enrolling 9433 women. The studies had moderate to high risk of bias due to evidence of reporting bias and insufficient adjustment for important covariates, particularly maternal body mass index. A fasting glucose target of <90 mg/dL was the most commonly reported and the one most strongly associated with reduced risk of macrosomia (odds ratio = 0.53, 95% confidence interval = 0.31-0.90, P = .02) for women with gestational diabetes during the third trimester. For type 1 and type 2 diabetes, and for pre- and postprandial targets, data were sparse and inconclusive. CONCLUSIONS: Evidence warranting very low confidence in the estimates suggests that a fasting glucose target of <90 mg/dL is associated with a lower risk of macrosomia and other outcomes of different importance in women with gestational diabetes. Whether this target can be extrapolated to women with pregestational diabetes or whether targets above or below this threshold offer a better benefit/risk balance remains unclear.
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A cutoff point of <90 mg/dL for preprandial value with other meals was associated with a similar reduction in risk but did not reach statistical significance (odds ratio = 0.69, 95% confidence interval = 0.17-2.94, P = .58).
“A cutoff point of <90 mg/dL (5.0 mmol/L) for preprandial value with other meals was associated with a similar reduction in risk but it did not reach statistical significance, likely due to the smaller sample size of that subgroup (odds ratio = 0.69, 95% confidence interval = 0.17–2.94, P = .58).”
From Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline (2013) · cites this paper as [108]
The analysis was associated with significant heterogeneity.
“The analysis was associated with significant heterogeneity.”
From Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline (2013) · cites this paper as [108]
The effect of the 90 mg/dL fasting plasma glucose cutoff was mainly demonstrated in women with gestational diabetes during the third trimester.
“This effect was mainly demonstrated in women with gestational diabetes during the third trimester.”
From Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline (2013) · cites this paper as [108]
The systematic review identified 34 original studies enrolling 9433 women.
“The review identified 34 original studies enrolling 9433 women (15 randomized controlled trials, 18 cohort studies, and 1 case-control study).”
From Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline (2013) · cites this paper as [108]
Data in women with type 1 and type 2 diabetes and for postprandial targets were sparse.
“Data in women with type 1 and type 2 diabetes and for postprandial targets were sparse.”
From Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline (2013) · cites this paper as [108]
The analysis controlled for study intervention, diabetes type, and trimester but was unable to control for maternal body mass index.
“The analysis controlled for study intervention, diabetes type, and trimester but was unable to control for maternal body mass index (BMI).”
From Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline (2013) · cites this paper as [108]
Meta-regression results demonstrated that a cutoff point of 90 mg/dL for fasting plasma glucose was associated with the most reduction in the risk of macrosomia (odds ratio = 0.53, 95% confidence interval = 0.31-0.90, P = .02).
“Meta-regression results demonstrated that a cutoff point of 90 mg/dL (5.0 mmol/L) for fasting plasma glucose was associated with the most reduction in the risk of macrosomia (odds ratio = 0.53, 95% confidence interval = 0.31–0.90, P = .02).”
From Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline (2013) · cites this paper as [108]
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- Authors
- Prutsky, G. J., Domecq, J. P., Wang, Z., Carranza Leon, B. G., Elraiyah, T., Nabhan, M., Sundaresh, V., Vella, A., Montori, V. M., & Murad, M. H.
- Affiliations
- Mayo Clinic (US)
- Henry Ford Hospital (US)
- Louisiana State University Health Sciences Center Shreveport (US)
- Corresponding author
- Murad, M. Hassan
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2013-11
- Volume
- 98
- Issue
- 11
- Pages
- 4319-4324
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2049244274
- Cited by
- 46
- References
- 22
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 1 · 2019: 3 · 2018: 5 · 2017: 5 · 2016: 4 · 2014: 6 · 2013: 1
- FWCI
- 0.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- glycemic targets, gestational diabetes mellitus, maternal diabetes, fasting blood glucose, macrosomia, fetal outcomes, maternal outcomes, pregestational diabetes, type 1 diabetes, type 2 diabetes, glycemic control in pregnancy
- MeSH terms
- Blood Glucose, Female, Humans, Hyperglycemia, Hypoglycemic Agents, Pregnancy, Pregnancy in Diabetics
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