Tighter Glycemic Targets for GDM Not Tied to Lower Risk for LGA Infants

THURSDAY, Sept. 15, 2022 (HealthDay News) -- For women with gestational diabetes mellitus (GDM), use of tighter versus less tight glycemic targets does not reduce the risk for infants being born large for gestational age but does reduce serious infant morbidity, according to a study published online Sept. 8 in PLOS Medicine.

Caroline A. Crowther, M.B., Ch.B., M.D., from the University of Auckland in New Zealand, and colleagues conducted a stepped-wedge, randomized trial at 10 hospitals. All hospitals initially used less tight targets (fasting plasma glucose [FPG] <5.5 mmol/L). Every four months, two hospitals moved to tighter targets (FPG ≤5.0 mmol/L). Data were included for 598 women with 602 infants using tighter targets and 502 women with 506 infants using less tight targets.

The researchers found that the rate of large for gestational age was similar between the treatment target groups (14.7 versus 15.1 percent). When adjusting for gestational age at diagnosis of GDM, body mass index, ethnicity, and history of GDM, the composite serious health outcome for the infant of perinatal death, birth trauma, or shoulder dystocia was reduced in the tighter versus the less tight group (1.3 versus 2.6 percent). In the tighter group, there was an increase observed in the composite serious health outcome for women, including major hemorrhage, coagulopathy, embolism, and obstetric complications (5.9 versus 3.0 percent).

"These findings have direct relevance for clinical practice and can be used to aid decisions on the choice of treatment targets to use when discussing glycemic control with women with GDM," the authors write.

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