Abstract
Objective In vivo study of glucose homeostasis in pregnancy suggests normal glucose levels are lower than current glycemic targets used in gestational diabetes. After the HAPO study results, our institution began using glycemic targets of fasting 85 mg/dL and 2-hour postprandial of 110 mg/dL. We reviewed our results. Methods A retrospective cohort of GDM patients that delivered at KUMC from January 2007 to May 2017 was reviewed. All patients were diagnosed with the 2-step Carpenter-Coustan thresholds. High targets were compared with low targets. The primary outcome investigated was birthweight > 90% (large for gestational age, LGA). Results 604 patients were studied, and 34% were treated with low glycemic targets. Our unadjusted results showed that the low-target group had a lower incidence of LGA infants (24.0 vs. 31.8%), higher incidence of neonatal hypoglycemia (20.7 vs. 11.6%), and inductions (39.4 vs. 20.5%). After adjustment for demographic variables, only a higher risk of inductions remained (aOR 2.54 (1.44, 4.49)). Conclusion Lower glycemic targets did not produce large reductions in fetal overgrowth, but they were associated with a higher rate of inductions. As there were no observed differences in maternal or neonatal outcomes otherwise, aiming for lower glycemic targets in GDM is likely not cost-effective.
Highlights
Gestational diabetes (GDM) is a frequent condition in otherwise normal pregnancies which leads to major morbidity for both the mother and the baby [1]
Our practice adopted lower glycemic targets based on the assumption that a glucose profile as close to euglycemia as possible would have the best outcomes
Results from the Hyperglycemia and Adverse Pregnancy Outcomes Study (HAPO) study showed that outcomes of macrosomia, cesarean delivery, and increased cord insulin levels increased with each stepwise increase in glucose recorded after the administration of a 75-gram 2-hour glucose tolerance test [7]
Summary
Gestational diabetes (GDM) is a frequent condition in otherwise normal pregnancies which leads to major morbidity for both the mother and the baby [1]. The glycemic targets that patients and clinicians should use are not supported by solid evidence [4, 5] Leaving this question unanswered means that patients will continue to experience morbidity unnecessarily. The current targets recommended by most organizations are a fasting < 95 mg/dL and a 2-hour postprandial < 120 mg/dL [1, 6] These targets may be too high if the goal is to approximate normal levels in pregnancy. Both the Hyperglycemia and Adverse Pregnancy Outcomes Study (HAPO) and a review of normal glycemic levels in uncomplicated pregnancies suggest that the mean is much lower than the current thresholds [4, 7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
