TY - JOUR
T1 - Glucose targets in pregnant women with diabetes
T2 - A systematic review and meta-analysis
AU - Prutsky, Gabriela J.
AU - Domecq, Juan Pablo
AU - Wang, Zhen
AU - Carranza Leon, Barbara G.
AU - Elraiyah, Tarig
AU - Nabhan, Mohammed
AU - Sundaresh, Vishnu
AU - Vella, Adrian
AU - Montori, Victor M.
AU - Murad, Mohammad Hassan
PY - 2013/11/1
Y1 - 2013/11/1
N2 - Background: Glucose-lowering treatments are used during pregnancy to reduce the risk for complications in the mother and offspring, yet treatment targets have not been established. Objective: Our objective was to appraise and summarize the available evidence regarding the association between different blood glucose targets during pregnancy and fetal and maternal outcomes. Methods: We searched Medline, EMBASE, Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL through May 2011 for randomized trials and observational studies that enrolled women with diabetesduringpregnancyandreportedplannedorachievedglucosetargets. Weusedrandom-effects meta-regression models to estimate the odds ratio for the association of outcomes of interest and glucose targets. When possible, we adjusted for diabetes type, trimester, and diabetes treatment. Results: We included 34 studies enrolling 9433 women. The studies had moderate to high risk of bias due to evidence of reporting bias and insufficient adjustment for important covariates, particularly maternal body mass index.Afasting glucose target of<90 mg/dL was the most commonly reported and the one most strongly associated with reduced risk of macrosomia (odds ratio=0.53, 95% confidence interval = 0.31-0.90, P = .02) for women with gestational diabetes during the third trimester. For type 1 and type 2 diabetes, and for pre- and postprandial targets, data were sparse and inconclusive. Conclusions: Evidence warranting very low confidence in the estimates suggests that a fasting glucose target of <90 mg/dL is associated with a lower risk of macrosomia and other outcomes of different importance inwomenwith gestational diabetes.Whetherthis target can be extrapolated to women with pregestational diabetes or whether targets above or below this threshold offer a better benefit/risk balance remains unclear.
AB - Background: Glucose-lowering treatments are used during pregnancy to reduce the risk for complications in the mother and offspring, yet treatment targets have not been established. Objective: Our objective was to appraise and summarize the available evidence regarding the association between different blood glucose targets during pregnancy and fetal and maternal outcomes. Methods: We searched Medline, EMBASE, Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL through May 2011 for randomized trials and observational studies that enrolled women with diabetesduringpregnancyandreportedplannedorachievedglucosetargets. Weusedrandom-effects meta-regression models to estimate the odds ratio for the association of outcomes of interest and glucose targets. When possible, we adjusted for diabetes type, trimester, and diabetes treatment. Results: We included 34 studies enrolling 9433 women. The studies had moderate to high risk of bias due to evidence of reporting bias and insufficient adjustment for important covariates, particularly maternal body mass index.Afasting glucose target of<90 mg/dL was the most commonly reported and the one most strongly associated with reduced risk of macrosomia (odds ratio=0.53, 95% confidence interval = 0.31-0.90, P = .02) for women with gestational diabetes during the third trimester. For type 1 and type 2 diabetes, and for pre- and postprandial targets, data were sparse and inconclusive. Conclusions: Evidence warranting very low confidence in the estimates suggests that a fasting glucose target of <90 mg/dL is associated with a lower risk of macrosomia and other outcomes of different importance inwomenwith gestational diabetes.Whetherthis target can be extrapolated to women with pregestational diabetes or whether targets above or below this threshold offer a better benefit/risk balance remains unclear.
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U2 - 10.1210/jc.2013-2461
DO - 10.1210/jc.2013-2461
M3 - Review article
C2 - 24151289
AN - SCOPUS:84887457016
SN - 0021-972X
VL - 98
SP - 4319
EP - 4324
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 11
ER -