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Perinatal Outcomes According to Treatment Targets for Gestational Diabetes: A Multi-Centre Retrospective Cohort Study

Stephanie L Montalto1, Melvin Marzan2, Christine Houlihan1

  • 1Mercy Health, Heidelberg, Victoria, Australia.

The Australian & New Zealand Journal of Obstetrics & Gynaecology
|August 1, 2025
PubMed

Insights

Tighter fasting blood glucose targets for gestational diabetes (GDM) did not improve infant outcomes but increased medication use. This study compared outcomes for GDM pregnancies with tighter versus less tight glucose control.

Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Perinatal Medicine

Background:

  • Gestational diabetes (GDM) affects 18% of pregnancies in Australia, potentially causing large for gestational age (LGA) infants and other complications.
  • Optimal treatment targets for GDM remain undefined, highlighting a critical gap in clinical guidelines.
  • Current GDM management lacks consensus on the ideal fasting blood glucose level (BGL) targets.

Purpose of the Study:

  • To compare perinatal outcomes in women with GDM treated to tighter versus less tight fasting blood glucose level (BGL) targets.
  • To evaluate the association between different GDM BGL targets and the incidence of large for gestational age (LGA) infants.
  • To assess the impact of GDM BGL targets on the need for pharmacotherapy.

Main Methods:

  • Retrospective cohort study of 25,041 births in 12 metropolitan Victorian hospitals (2020-2022).
  • Inclusion criteria: term singleton infants with GDM diagnosis.
  • Comparison of outcomes between 'tighter' (BGL < 5.0-5.2 mmol/L) and 'less tight' (BGL < 5.5-5.6 mmol/L) fasting BGL target groups, using multilevel Poisson regression with inverse probability treatment weighting.

Main Results:

  • No significant difference in LGA births between tighter (10.4%) and less tight (9.5%) BGL target groups (p=0.85).
  • Increased insulin treatment in the tighter BGL target group (53% vs. 35%, p<0.001).
  • No significant differences observed in secondary perinatal outcomes between the groups.

Conclusions:

  • Tighter fasting BGL targets in GDM pregnancies are not associated with improved perinatal outcomes.
  • Implementing tighter BGL targets leads to a higher likelihood of requiring pharmacotherapy, such as insulin.
  • The findings suggest that current tighter fasting BGL targets for GDM may not offer clinical benefits regarding infant size and increase medical intervention rates.
Abstract

Keywords:
diabetes complicationsgestational diabetesperinatal care

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