Different intensities of glycaemic control for pregnant women with pre-existing diabetes

During pregnancy, loose glycaemic control (fasting blood glucose 6.7 to 8.9 mmol/L) might possibly increase pre-eclampsia, caesarean sections, and macrosomia compared with tight-moderate glycaemic control (fasting blood glucose under or 6.7 mmol/L) in women with type 1 diabetes, although the data are insufficient.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, no blinding, selective reporting) and by imprecise results (few patients and outcome events, wide confidence intervals).

Summary

A Cochrane review included 3 studies with a total of 233 subjects. In a trial of 60 women and babies comparing tight (≤ 5.6 mmol/L fasting blood glucose (FBG)); moderate (5.6 to 6.7); and loose (6.7 to 8.9) glycaemic control targets, there were 2 neonatal deaths in the loose and none in the tight or moderate groups. There were significantly fewer women with pre-eclampsia (RR 0.11, 95% CI 0.01 to 0.99), fewer caesareans (RR 0.28, 95% CI 0.10 to 0.78), and fewer birthweights greater than 90th centile (RR 0.01, 95% CI 0.00 to 0.20) in the combined tight-moderate compared with the loose group. Two trials compared very tight (3.33 to 5.0 mmol/L FBG) with tight-moderate (4.45 to 6.38) glycaemic control targets. In these two trials glycaemic control was not significantly different between the very tight and tight-moderate groups by the third trimester. No significant differences were seen.

Clinical comments

Date of latest search: 31 January 2016

Ədəbiyyat

1. Middleton P, Crowther CA, Simmonds L. Different intensities of glycaemic control for pregnant women with pre-existing diabetes. Cochrane Database Syst Rev 2012;(8):CD008540 [Assessed as up-to-date: 31 January 2016].