Skip to main content
SpringerLink
Log in

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

  • Diabetes and Pregnancy (CJ Homko, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Freinkel N. Banting Lecture 1980. Of pregnancy and progeny. Diabetes. 1980;29(12):1023–35.

    Article  CAS  PubMed  Google Scholar 

  2. Silverman BL, Metzger BE, Cho NH, Loeb CA. Impaired glucose tolerance in adolescent offspring of diabetic mothers relationship to fetal hyperinsulinism. Diabetes Care. 1995;18(5):611–7.

    Article  CAS  PubMed  Google Scholar 

  3. Vohr BR, McGarvey ST, Tucker R. Effects of maternal gestational diabetes on offspring adiposity at 4–7 years of age. Diabetes Care. 1999;22(8):1284–91.

    Article  CAS  PubMed  Google Scholar 

  4. Dabelea D, Hanson RL, Lindsay RS, Pettitt DJ, Imperatore G, Gabir MM, et al. Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships. Diabetes. 2000;49(12):2208–11.

    Article  CAS  PubMed  Google Scholar 

  5. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005;115(3):e290–6.

    Article  PubMed  Google Scholar 

  6. Mestman JH. Historical notes on diabetes and pregnancy. Endocrinologist. 2002;12:224–42.

    Article  Google Scholar 

  7. Fraser R. Diabetic control in pregnancy and intrauterine growth of the fetus. Br J Obstet Gynaecol. 1995;102(4):275–7.

    Article  CAS  PubMed  Google Scholar 

  8. Visser GHA, van Ballegooie E, Stuiter WJ. Macrosomia despite well-controlled diabetic pregnancy. Lancet. 1984;1:284–5.

    Google Scholar 

  9. Dandona P, Besterman HS, Freedman DB, Boag F, Taylor AM, Beckett AG. Macrosomia despite well-controlled diabetic pregnancy. Lancet. 1984;1(8379):737.

    Article  CAS  PubMed  Google Scholar 

  10. Combs CA, Gunderson E, Kitzmiller JL, Gavin LA, Main EK. Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy. Diabetes Care. 1992;15(10):1251–7.

    Article  CAS  PubMed  Google Scholar 

  11. Metzger BE, Phelps RL, Freinkel N, Navickas IA. Effects of gestational diabetes on diurnal profiles of plasma glucose, lipids, and individual amino acids. Diabetes Care. 1980;3(3):402–9.

    Article  CAS  PubMed  Google Scholar 

  12. Kalkhoff RK, Kissebah AH, Kim HJ. Carbohydrate and lipid metabolism during normal pregnancy: relationship to gestational hormone action. Semin Perinatol. 1978;2(4):291–307.

    CAS  PubMed  Google Scholar 

  13. Bleicher SJ, O’Sullivan JB, Freinkel N. Carbohydrate metabolism in pregnancy. V. The interrelations of glucose, insulin and free fatty acids in late pregnancy and post partum. N Engl J Med. 1964;271:866–72.

    Article  CAS  PubMed  Google Scholar 

  14. Kalkhoff RK, Kandaraki E, Morrow PG, Mitchell TH, Kelber S, Borkowf HI. Relationship between neonatal birth weight and maternal plasma amino acid profiles in lean and obese nondiabetic women and in type I diabetic pregnant women. Metabolism. 1988;37(3):234–9.

    Article  CAS  PubMed  Google Scholar 

  15. Schaefer-Graf UM, Graf K, Kulbacka I, Kjos SL, Dudenhausen J, Vetter K, et al. Maternal lipids as strong determinants of fetal environment and growth in pregnancies with gestational diabetes mellitus. Diabetes Care. 2008;31(9):1858–63.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Harmon KA, Gerard L, Jensen DR, Kealey EH, Hernandez TL, Reece MS, et al. Continuous glucose profiles in obese and normal-weight pregnant women on a controlled diet: metabolic determinants of fetal growth. Diabetes Care. 2011;34(10):2198–204.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Olmos PR, Rigotti A, Busso D, Berkowitz L, Santos JL, Borzone GR, Poblete JA, Vera C, Belmar C, Goldenberg D, Samith B, Acosta AM, Escalona M, Niklitschek I, Mandiola JR, Mertens N. Maternal hypertriglyceridemia: a link between maternal overweight-obesity and macrosomia in gestational diabetes. Obesity (Silver Spring) 2014

  18. Barrett HL, Dekker NM, McIntyre HD, Callaway LK. Normalizing metabolism in diabetic pregnancy: is it time to target lipids. Diabetes Care. 2014;37(5):1484–93. This paper provides a thorough discussion of lipid metabolism in pregnancies complicated by diabetes. Because contemporary evidence supports a role for maternal lipids in fetal overgrowth, the authors address the potential for treating maternal dyslipidemia to improve perinatal outcomes.

    Article  CAS  PubMed  Google Scholar 

  19. Hernandez TL, Friedman JE, van Pelt RE, Barbour LA. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged. Diabetes Care. 2011;34(7):1660–8. A systematic review of data spanning 50 years describing normoglycemia in pregnancy. Based on pooled analysis of weighted average glucose data, more aggressive therapeutic targets for pregnancies affected by diabetes are suggested for future clinical trials.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Hod M, Yogev Y. Goals of metabolic management of gestational diabetes: is it all about the sugar? Diabetes Care. 2007;30 Suppl 2:S180–7.

    Article  CAS  PubMed  Google Scholar 

  21. Hare JW. Gestational diabetes mellitus. Levels of glycemia as management goals. Diabetes. 1991;40 Suppl 2:193–6.

    Article  PubMed  Google Scholar 

  22. Jovanovic L. American Diabetes Association’s Fourth International Workshop-Conference on Gestational Diabetes Mellitus: summary and discussion. Therapeutic interventions. Diabetes Care. 1998;21 Suppl 2:B131–7.

    PubMed  Google Scholar 

  23. American Diabetes Association Workshop-Conference on gestational diabetes: summary and recommendations. Diabetes Care 1980;3(3):499–501

  24. Proceedings of the Second International Workshop-Conference on Gestational Diabetes Mellitus. October 25–27, 1984, Chicago, Illinois. Diabetes 1985;34 Suppl 2:1–130

  25. Metzger BE. Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes. 1991;40 Suppl 2:197–201.

    Article  PubMed  Google Scholar 

  26. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care. 1998;21 Suppl 2:B161–7.

    PubMed  Google Scholar 

  27. Metzger BE, Buchanan TA, Coustan D, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30 Suppl 2:S251–60.

    Article  CAS  PubMed  Google Scholar 

  28. Tonyushkina K, Nichols JH. Glucose meters: a review of technical challenges to obtaining accurate results. J Diabetes Sci Technol. 2009;3(4):971–80.

    Article  PubMed Central  PubMed  Google Scholar 

  29. D’Orazio P, Burnett RW, Fogh-Andersen N, Jacobs E, Kuwa K, Kulpmann WR, et al. Approved IFCC recommendation on reporting results for blood glucose (abbreviated). Clin Chem. 2005;51(9):1573–6.

    Article  PubMed  Google Scholar 

  30. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144(7):768–73.

    CAS  PubMed  Google Scholar 

  31. O’Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964;13:278–85.

    PubMed  Google Scholar 

  32. Metzger BE. 1990 overview of GDM. Accomplishments of the last decade—challenges for the future. Diabetes. 1991;40 Suppl 2:1–2.

    Article  PubMed  Google Scholar 

  33. Gabbe SG. Discussion of, "A rationale for omitting two-hour postprandial glucose determinations in gestational diabetes". Am J Obstet Gynecol. 1993;169(2 Pt 1):262–3.

    Google Scholar 

  34. O’Sullivan JB, Mahan CM, Charles D, Dandrow RV. Screening criteria for high-risk gestational diabetic patients. Am J Obstet Gynecol. 1973;116(7):895–900.

    PubMed  Google Scholar 

  35. Gabbe SG. Discussion of, "A rationale for omitting two-hour postprandial glucose determinations in gestational diabetes". Am J Obstet Gynecol. 1993;169(2 Pt 1):262–3.

    Google Scholar 

  36. Persson B, Stangenberg M, Hansson U, Nordlander E. Gestational diabetes mellitus (GDM). Comparative evaluation of two treatment regimens, diet versus insulin and diet. Diabetes. 1985;34 Suppl 2:101–5.

    Article  PubMed  Google Scholar 

  37. Landon MB, Gabbe SG. Antepartum fetal surveillance in gestational diabetes mellitus. Diabetes. 1985;34 Suppl 2:50–4.

    Article  PubMed  Google Scholar 

  38. De HR. Monitoring the severity of metabolic disturbances and effectiveness of management of gestational diabetes mellitus. Diabetes. 1991;40 Suppl 2:157–60.

    Google Scholar 

  39. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2002;48(3):436–72.

    CAS  PubMed  Google Scholar 

  40. Consensus statement on self-monitoring of blood glucose. Diabetes Care 1987;10(1):95–99.

  41. Tallarigo L, Giampietro O, Penno G, Miccoli R, Gregori G, Navalesi R. Relation of glucose tolerance to complications of pregnancy in nondiabetic women. N Engl J Med. 1986;315(16):989–92.

    Article  CAS  PubMed  Google Scholar 

  42. Langer O, Mazze R. The relationship between large-for-gestational-age infants and glycemic control in women with gestational diabetes. Am J Obstet Gynecol. 1988;159(6):1478–83.

    Article  CAS  PubMed  Google Scholar 

  43. Langer O, Levy J, Brustman L, Anyaegbunam A, Merkatz R, Divon M. Glycemic control in gestational diabetes mellitus—how tight is tight enough: small for gestational age versus large for gestational age? Am J Obstet Gynecol. 1989;161(3):646–53.

    Article  CAS  PubMed  Google Scholar 

  44. Gillmer MD, Beard RW, Brooke FM, Oakley NW. Carbohydrate metabolism in pregnancy. Part I. Diurnal plasma glucose profile in normal and diabetic women. Br Med J. 1975;3(5980):399–402.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Lewis SB, Wallin JD, Kuzuya H, Murray WK, Coustan DR, Daane TA, et al. Circadian variation of serum glucose, C-peptide immunoreactivity and free insulin normal and insulin-treated diabetic pregnant subjects. Diabetologia. 1976;12(4):343–50.

    Article  CAS  PubMed  Google Scholar 

  46. Cousins L, Rigg L, Hollingsworth D, Brink G, Aurand J, Yen SS. The 24-hour excursion and diurnal rhythm of glucose, insulin, and C-peptide in normal pregnancy. Am J Obstet Gynecol. 1980;136(4):483–8.

    CAS  PubMed  Google Scholar 

  47. Phelps RL, Metzger BE, Freinkel N. Carbohydrate metabolism in pregnancy. XVII. Diurnal profiles of plasma glucose, insulin, free fatty acids, triglycerides, cholesterol, and individual amino acids in late normal pregnancy. Am J Obstet Gynecol. 1981;140(7):730–6.

    CAS  PubMed  Google Scholar 

  48. McFarland MB, Langer O, Conway DL, Berkus MD. Dietary therapy for gestational diabetes: how long is long enough? Obstet Gynecol. 1999;93(6):978–82.

    Article  CAS  PubMed  Google Scholar 

  49. Jovanovic-Peterson L, Peterson CM, Reed GF, Metzger BE, Mills JL, Knopp RH, et al. Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development—Diabetes in Early Pregnancy Study. Am J Obstet Gynecol. 1991;164(1 Pt 1):103–11.

    Article  CAS  PubMed  Google Scholar 

  50. de Veciana M, Major CA, Morgan MA, Asrat T, Toohey JS, Lien JM, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med. 1995;333(19):1237–41.

    Article  PubMed  Google Scholar 

  51. Huddleston JF, Cramer MK, Vroon DH. A rationale for omitting two-hour postprandial glucose determinations in gestational diabetes. Am J Obstet Gynecol. 1993;169(2 Pt 1):257–62.

    Article  CAS  PubMed  Google Scholar 

  52. Parfitt VJ, Clark JD, Turner GM, Hartog M. Maternal postprandial blood glucose levels influence infant birth weight in diabetic pregnancy. Diabetes Res. 1992;19(3):133–5.

    CAS  PubMed  Google Scholar 

  53. Thompson DM, Dansereau J, Creed M, Ridell L. Tight glucose control results in normal perinatal outcome in 150 patients with gestational diabetes. Obstet Gynecol. 1994;83(3):362–6.

    CAS  PubMed  Google Scholar 

  54. Victor A. Normal blood sugar variation during pregnancy. Acta Obstet Gynecol Scand. 1974;53(1):37–40.

    Article  CAS  PubMed  Google Scholar 

  55. Buchanan TA, Kjos SL, Montoro MN, Wu PY, Madrilejo NG, Gonzalez M, et al. Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. Diabetes Care. 1994;17(4):275–83.

    Article  CAS  PubMed  Google Scholar 

  56. Willman SP, Leveno KJ, Guzick DS, Williams ML, Whalley PJ. Glucose threshold for macrosomia in pregnancy complicated by diabetes. Am J Obstet Gynecol. 1986;154(2):470–5.

    Article  CAS  PubMed  Google Scholar 

  57. Demarini S, Mimouni F, Tsang RC, Khoury J, Hertzberg V. Impact of metabolic control of diabetes during pregnancy on neonatal hypocalcemia: a randomized study. Obstet Gynecol. 1994;83(6):918–22.

    Article  CAS  PubMed  Google Scholar 

  58. Moses RG, Lucas EM, Knights S. Gestational diabetes mellitus. At what time should the postprandial glucose level be monitored? Aust N Z J Obstet Gynaecol. 1999;39(4):457–60.

    Article  CAS  PubMed  Google Scholar 

  59. Sivan E, Weisz B, Homko CJ, Reece EA, Schiff E. One or two hours postprandial glucose measurements: are they the same? Am J Obstet Gynecol. 2001;185(3):604–7.

    Article  CAS  PubMed  Google Scholar 

  60. Weisz B, Shrim A, Homko CJ, Schiff E, Epstein GS, Sivan E. One hour versus two hours postprandial glucose measurement in gestational diabetes: a prospective study. J Perinatol. 2005;25(4):241–4.

    Article  CAS  PubMed  Google Scholar 

  61. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24):2477–86.

    Article  CAS  PubMed  Google Scholar 

  62. Parretti E, Mecacci F, Papini M, Cioni R, Carignani L, Mignosa M, et al. Third-trimester maternal glucose levels from diurnal profiles in nondiabetic pregnancies: correlation with sonographic parameters of fetal growth. Diabetes Care. 2001;24(8):1319–23.

    Article  CAS  PubMed  Google Scholar 

  63. Chen R, Yogev Y, Ben Haroush A, Jovanovic L, Hod M, Phillip M. Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2003;14(4):256–60.

    Article  CAS  PubMed  Google Scholar 

  64. Ben Haroush A, Yogev Y, Chen R, Rosenn B, Hod M, Langer O. The postprandial glucose profile in the diabetic pregnancy. Am J Obstet Gynecol. 2004;191(2):576–81.

    Article  CAS  PubMed  Google Scholar 

  65. Yogev Y, Ben Haroush A, Chen R, Rosenn B, Hod M, Langer O. Diurnal glycemic profile in obese and normal weight nondiabetic pregnant women. Am J Obstet Gynecol. 2004;191(3):949–53.

    Article  CAS  PubMed  Google Scholar 

  66. Sermer M, Naylor CD, Gare DJ, Kenshole AB, Ritchie JW, Farine D, et al. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes. The Toronto Tri-Hospital Gestational Diabetes Project. Am J Obstet Gynecol. 1995;173(1):146–56.

    Article  CAS  PubMed  Google Scholar 

  67. Bonomo M, Corica D, Mion E, Goncalves D, Motta G, Merati R, et al. Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance: a randomized clinical trial. Diabet Med. 2005;22(11):1536–41.

    Article  CAS  PubMed  Google Scholar 

  68. Mello G, Parretti E, Mecacci F, La TP, Cioni R, Cianciulli D, et al. What degree of maternal metabolic control in women with type 1 diabetes is associated with normal body size and proportions in full-term infants? Diabetes Care. 2000;23(10):1494–8.

    Article  CAS  PubMed  Google Scholar 

  69. Howorka K, Pumprla J, Gabriel M, Feiks A, Schlusche C, Nowotny C, et al. Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out-patient education adapted for pregnancy. Diabet Med. 2001;18(12):965–72.

    Article  CAS  PubMed  Google Scholar 

  70. Kjos SL, Schaefer-Graf U, Sardesi S, Peters RK, Buley A, Xiang AH, et al. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care. 2001;24(11):1904–10.

    Article  CAS  PubMed  Google Scholar 

  71. Schaefer-Graf UM, Kjos SL, Fauzan OH, Buhling KJ, Siebert G, Buhrer C, et al. A randomized trial evaluating a predominantly fetal growth-based strategy to guide management of gestational diabetes in Caucasian women. Diabetes Care. 2004;27(2):297–302.

    Article  PubMed  Google Scholar 

  72. Bonomo M, Cetin I, Pisoni MP, Faden D, Mion E, Taricco E, et al. Flexible treatment of gestational diabetes modulated on ultrasound evaluation of intrauterine growth: a controlled randomized clinical trial. Diabetes Metab. 2004;30(3):237–44.

    Article  CAS  PubMed  Google Scholar 

  73. Kjos SL, Schaefer-Graf UM. Modified therapy for gestational diabetes using high-risk and low-risk fetal abdominal circumference growth to select strict versus relaxed maternal glycemic targets. Diabetes Care. 2007;30 Suppl 2:S200–5.

    Article  PubMed  Google Scholar 

  74. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002.

    Article  PubMed  Google Scholar 

  75. Porter H, Lookinland S, Belfort MA. Evaluation of a new real-time blood continuous glucose monitoring system in pregnant women without gestational diabetes. A pilot study. J Perinat Neonatal Nurs. 2004;18(2):93–102.

    Article  PubMed  Google Scholar 

  76. Cypryk K, Pertynska-Marczewska M, Szymczak W, Wilcynski J, Lewinski A. Evaluation of metabolic control in women with gestational diabetes mellitus by the continuous glucose monitoring system: a pilot study. Endocr Pract. 2006;12(3):245–50.

    Article  PubMed  Google Scholar 

  77. Siegmund T, Rad NT, Ritterath C, Siebert G, Henrich W, Buhling KJ. Longitudinal changes in the continuous glucose profile measured by the CGMS in healthy pregnant women and determination of cut-off values. Eur J Obstet Gynecol Reprod Biol. 2008;139(1):46–52.

    Article  PubMed  Google Scholar 

  78. Riskin-Mashiah S, Damti A, Younes G, Auslander R. Normal fasting plasma glucose levels during pregnancy: a hospital-based study. J Perinat Med. 2011;39(2):209–11.

    PubMed  Google Scholar 

  79. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82.

    Article  PubMed  Google Scholar 

  80. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361(14):1339–48.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  81. Prutsky GJ, Domecq JP, Wang Z, Carranza Leon BG, Elraiyah T, Nabhan M, et al. Glucose targets in pregnant women with diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2013;98(11):4319–24. This manuscript highlights the very low quality of evidence supporting glucose targets in pregnancies affected by diabetes in terms of their association with maternal and fetal outcomes. The study is a systematic review and meta-analysis of glucose targets in pregnancy (34 studies, 9433 women) commissioned by the Endocrine Society.

    Article  CAS  PubMed  Google Scholar 

  82. Standards of medical care in diabetes–2014. Diabetes Care 2014;37 Suppl 1:S14-S80.

  83. American College of Obstetricians and Gynecologists. ACOG practice bulletin: gestational diabetes mellitus. Washington, DC: American College of Obstetricians and Gynecologists; 2013. Report No.: 137.

  84. Blumer I, Hadar E, Hadden DR, Jovanovic L, Mestman JH, Murad MH, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(11):4227–49.

    Article  CAS  PubMed  Google Scholar 

  85. Nankervis A, McIntyre HD, Moses RG et al. ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia (May 2013: Version 2). Australian Diabetes in Pregnancy Society 2013;Available at: URL: www.adips.org/information-for-health-care-providers-approved.asp.

  86. Thompson D, Berger H, Feig D, Gagnon R, Kader T, Keely E, et al. Diabetes and pregnancy. Can J Diabetes. 2013;37 Suppl 1:S168–83.

    Article  PubMed  Google Scholar 

  87. National Institute for Health and Care Excellence (NICE). Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period. 2008. Report No.: CG63.

  88. Nankervis A, McIntyre HD, Moses RG, Ross GP, Callaway LK. Testing for gestational diabetes mellitus in Australia. Diabetes Care. 2013;36(5):e64.

    Article  PubMed Central  PubMed  Google Scholar 

  89. World Health Organization. Diagnostic criteria and classification of hyperglycemia first detected in pregnancy. 2013. Report No.: WHO/NMH/MND/13.2.

  90. Metzger BE, Buchanan TA, Coustan D, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30 Suppl 2:S251–60.

    Article  CAS  PubMed  Google Scholar 

  91. Ryan EA. Diagnosing gestational diabetes. Diabetologia. 2011;54(3):480–6. This paper provides a thorough discussion of how the new diagnostic criteria for gestational diabetes, based on a 1.75-fold increased risk for delivering a large-for-gestational age infant, were derived from the Hyperglycemia and Adverse Pregnancy Outcomes trial. Using data from the trial, the author points out that maternal BMI had a greater influence on the risk for large for gestational age than glucose, and urges more discussion of the targets before implementation.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  92. Pedersen J. Weight and length at birth of infants of diabetic mothers. Acta Endocrinol (Copenh). 1954;16(4):330–42.

    CAS  Google Scholar 

  93. Merriam-Webster. Merriam-Webster on-line dictionary and thesaurus. Merriam-Webster, Inc 2014;Available at: URL: www.merriam-webster.com. Accessed July 26, 14 A.D.

  94. Mainland D. Remarks on clinical "norms". Clin Chem. 1971;17(4):267–74.

    CAS  PubMed  Google Scholar 

  95. Rey E, Attie C, Bonin A. The effects of first-trimester diabetes control on the incidence of macrosomia. Am J Obstet Gynecol. 1999;181(1):202–6.

    Article  CAS  PubMed  Google Scholar 

  96. Henriksen T. The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand. 2008;87(2):134–45.

    Article  PubMed  Google Scholar 

  97. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Int J Gynaecol Obstet 2002;78(1):69–77.

  98. Sacks DA, Chen W, Greenspoon JS, Wolde-Tsadik G. Should the same glucose values be targeted for type 1 as for type 2 diabetics in pregnancy? Am J Obstet Gynecol. 1997;177(5):1113–9.

    Article  CAS  PubMed  Google Scholar 

  99. Langer O. Glycemic targets for the optimal treatment of GDM. Clin Obstet Gynecol. 2013;56(4):788–802.

    Article  PubMed  Google Scholar 

  100. Nielsen LR, Pedersen-Bjergaard U, Thorsteinsson B, Johansen M, Damm P, Mathiesen ER. Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care. 2008;31(1):9–14.

    Article  PubMed  Google Scholar 

  101. Robertson H, Pearson DW, Gold AE. Severe hypoglycaemia during pregnancy in women with type 1 diabetes is common and planning pregnancy does not decrease the risk. Diabet Med. 2009;26(8):824–6.

    Article  CAS  PubMed  Google Scholar 

  102. Heller S, Damm P, Mersebach H, Skjoth TV, Kaaja R, Hod M, et al. Hypoglycemia in type 1 diabetic pregnancy: role of preconception insulin aspart treatment in a randomized study. Diabetes Care. 2010;33(3):473–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  103. Barbour LA. Changing perspectives in pre-existing diabetes in pregnancy and gestational diabetes: maternal and infant short- and long-term outcomes. Curr Opin Endocrinol Diabetes Obes. 2014;21:257–63.

    Article  CAS  PubMed  Google Scholar 

  104. Schauer IE, Snell-Bergeon JK, Bergman BC, Maahs DM, Kretowski A, Eckel RH, et al. Insulin resistance, defective insulin-mediated fatty acid suppression, and coronary artery calcification in subjects with and without type 1 diabetes: the CACTI study. Diabetes. 2011;60(1):306–14.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  105. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005;115(3):485–91.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Dr. Linda A. Barbour, a champion for pregnant women with diabetes, has been my teacher, mentor, and friend for over a decade. Her critical review of this manuscript is acknowledged with deep appreciation. Funding support from the following sources is further acknowledged: National Institutes of Health (R21 DK 088324), the Center for Women’s Health Research, the NIH/NCATS Colorado Clinical and Translational Research Institute (UL1 TR000154), the Colorado Nutrition and Obesity Research Center (NORC; NIH P30 DK 048520–15), and the Colorado Program for Nutrition and Healthy Development.

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Teri L. Hernandez declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, 12801 E. 17th Avenue, MS8106, Aurora, CO, 80045, USA

    Teri L. Hernandez

  2. College of Nursing, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA

    Teri L. Hernandez

  3. Colorado Pediatric Nurse Scientist Program, Children’s Hospital Colorado, Aurora, CO, USA

    Teri L. Hernandez

Authors
  1. Teri L. Hernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Teri L. Hernandez.

Additional information

This article is part of the Topical Collection on Diabetes and Pregnancy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hernandez, T.L. Glycemic Targets in Pregnancies Affected by Diabetes: Historical Perspective and Future Directions. Curr Diab Rep 15, 565 (2015). https://doi.org/10.1007/s11892-014-0565-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-014-0565-2

Keywords

Search

Navigation