TOPLINE:

Tight glycemic targets in women with gestational diabetes reduced the risk for large-for-gestational-age births and cesarean deliveries, without increasing the risk for serious maternal or neonatal complications.

METHODOLOGY:

• Gestational diabetes affects 2%-30% of pregnancies globally, and greater maternal hyperglycemia significantly increases the risk for large-for-gestational-age infants; therefore, effective glycemic control is essential to reduce adverse maternal and neonatal outcomes.
• In this clinical trial, 626 women with gestational diabetes and singleton pregnancies were randomly assigned to the tight glycemic target (fasting < 5.1 mmol/L; 1‑hour postprandial < 7.0 mmol/L) or less tight glycemic target (fasting < 5.3 mmol/L; 1‑hour postprandial < 7.8 mmol/L) groups at 12-31 weeks of gestation to compare pregnancy outcomes.
• All women received standardized counseling on diet and physical activity, self-monitored their blood glucose daily, and recorded their readings and food intake. Records were reviewed during periodic endocrinology consultations, and the need for insulin therapy was assessed.
• The primary outcome was the incidence of large-for-gestational-age infants, defined as birth weight above the 90th percentile for gestational age and sex.
• Secondary outcomes encompassed various measures of maternal and neonatal health.

TAKEAWAY:

• The tight target group had a significantly lower incidence of large-for-gestational-age births than the less tight target group (19.2% vs 26.5%; adjusted relative risk [aRR], 0.61; P = .010).
• A tight glycemic target was associated with lower rates of cesarean delivery than a less tight glycemic target (aRR, 0.63; P = .012), along with a modestly lower median gestational weight gain (10.1 vs 10.7 kg; P = .006).
• Insulin therapy was required more often in the tight target group; however, rates of serious maternal complications and maternal hypoglycemia remained low and were similar between groups.
• Rates of neonatal complications were also similar between groups.

IN PRACTICE:

“These findings support reconsidering current glycemic thresholds in international guidelines, particularly for women at high risk of LGA [large-for-gestational-age infants],” the authors of the study wrote.

SOURCE:

The study was led by Polina V. Popova, Almazov National Medical Research Centre, Saint Petersburg, Russia. It was published online in Diabetes Research and Clinical Practice.

LIMITATIONS:

The trial was conducted at a single Russian center, which may limit the generalizability of the findings to populations with different genetic backgrounds, healthcare systems, or severity of gestational diabetes. The trial was open-label, which could have influenced clinical decisions. In addition, long-term follow-up of mothers or infants was not performed.

DISCLOSURES:

The study was supported by the Russian Science Foundation and a government-funded research project (No. 125042105343-8). The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.