Glycemic Targets in Pregnancies Affected by Diabetes: Historical Perspective and Future Directions

• Published in: Current Diabetes Reports Vol. 15; no. 1; p. 565
• Main Author: Hernandez, Teri L.
• Format: Journal Article Book Review
• Language: English
• Published: Boston Springer US 2015; Springer Nature B.V
• Subjects: Adult; Birth Weight; Body Mass Index; Diabetes; Diabetes and Pregnancy (CJ Homko; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - history; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - history; Diabetes, Gestational - blood; Diabetes, Gestational - history; Female; Fetal Macrosomia - history; Fetal Macrosomia - prevention & control; Glycated Hemoglobin A - metabolism; Glycemic Index; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Infant, Newborn; Medicine; Medicine & Public Health; Meta-Analysis as Topic; Postprandial Period; Pregnancy; Pregnancy in Diabetics - blood; Pregnancy in Diabetics - history; Randomized Controlled Trials as Topic; Section Editor; Topical Collection on Diabetes and Pregnancy; Fetal growth; Type 2 diabetes; Glucometer; Lipids; Glucose; Glucose targets; Metabolism; Macrosomia; Pregnancy; CGMS; Type 1 diabetes; Gestational diabetes; Glycemia
• ISSN: 1534-4827; 1539-0829
• DOI: 10.1007/s11892-014-0565-2

The definition of optimal glycemic control in pregnancies affected by diabetes remains enigmatic. Diabetes phenotypes are heterogeneous. Moreover, fetal macrosomia insidiously occurs even with excellent glycemic control. Current blood glucose (BG) targets (FBG ≤95, 1-h post-prandial <140, 2 h <120 mg/dL) have improved perinatal outcomes, but arguably they have not normalized. The conventional management approach has been to replicate a pattern of glycemia in normal pregnancy. Although these patterns are lower than previously appreciated, a randomized controlled trial (RCT) has never compared current vs. lower glucose targets powered on maternal/fetal outcomes. This paper provides historical context to the current targets by reviewing evidence supporting their evolution. Using lower targets (FBG <90, 1 h <122, 2 h <110, mean BG ≤95 mg/dL) may help normalize outcomes, but phenotypic differences (type 1 vs. type 2 vs. gestational diabetes) might require different glycemic goals. There remains a critical need for well-designed RCTs to confirm optimal glycemic control that minimizes both small for and large for gestational age across pregnancies affected by diabetes.