Does tight maternal glycaemic control reduce the risk of neonatal hypoglycaemia?

Question 2

PICO (Population, Intervention, Comparison, Outcome): Should tighter maternal glycaemic control during pregnancy in women with diabetes vs. less-tight maternal glycaemic control during pregnancy be used for preventing neonatal hypoglycaemia?

Recommendation

Tighter glycaemic control during pregnancy is suggested for women with diabetes. Follow recommendations of the national guideline – “Testing for, diagnosing and managing gestational diabetes (diabetes of pregnancy) Te whakamātau, te tautohu me te whakahaere i te mate huka hapūtanga”. [Conditional recommendation]

Justifications

Low certainty evidence showed that tight maternal glycaemic control during pregnancy compared to less tight had little to no effect on neonatal hypoglycaemia, but resulted in a small reduction in mortality and morbidity, and admissions to NICU.

However, adverse effects for mothers when using tight targets should be considered. Women may have difficulty in adhering to tighter glycaemic targets.

Implementation considerations

See the national guideline “Testing for, diagnosing and managing gestational diabetes (diabetes of pregnancy) Te whakamātau, te tautohu me te whakahaere i te mate huka hapūtanga”.

Monitoring and evaluation

The national guideline “Testing for, diagnosing and managing gestational diabetes (diabetes of pregnancy) Te whakamātau, te tautohu me te whakahaere i te mate huka hapūtanga” suggests that tight targets are frequently harder to achieve, which may explain poor adherence to tight targets. Monitoring of adherence is recommended.

Research priorities

Studies are needed on:

  1. The effect of tight maternal glycaemic control on neonatal hypoglycaemia and long-term childhood outcomes.
  2. Factors influencing adherence to tight glycaemic control targets in pregnancy and how whānau can be supported to achieve these, particularly in specific populations.
  3. Patient values and preferences surrounding tight glycaemic control in pregnancy.
  4. The cost-effectiveness of employing tight glycaemic control in pregnancy.

Health equity

Gestational diabetes occurs at higher rates in Māori, Pacific, Asian, and Indian populations. Health professionals working alongside these population groups need to work towards tight glycaemic control in a pro-equity approach to improve outcomes. Health professionals should ensure that glycaemic targets are based on clinical guidelines and individual patient needs prioritising those who are most affected by issues such as access and systemic privilege, to avoid potential harm and ensure equitable care.