Glycemia and its relationship to outcomes in the metformin in gestational diabetes trial.
OBJECTIVE
To determine how glucose control in women with GDM treated with metformin and/or insulin influenced pregnancy outcomes.


METHODS
Women randomly assigned to metformin or insulin treatment in the Metformin in Gestational Diabetes (MiG) trial had baseline glucose tolerance test (OGTT) results and A1C documented, together with all capillary glucose measurements during treatment. In the 724 women who had glucose data for analysis, tertiles of baseline glucose values and A1C and of mean capillary glucose values during treatment were calculated. The relationships between maternal factors, glucose values, and outcomes (including a composite of neonatal complications, preeclampsia, and large-for-gestational-age [LGA] and small-for-gestational-age infants) were examined with bivariable and multivariate models.


RESULTS
Baseline OGTT did not predict outcomes, but A1C predicted LGA infants (P = 0.003). During treatment, fasting capillary glucose predicted neonatal complications (P < 0.001) and postprandial glucose predicted preeclampsia (P = 0.016) and LGA infants (P = 0.001). Obesity did not influence outcomes, and there was no interaction between glycemic control, randomized treatment, or maternal BMI in predicting outcomes. The lowest risk of complications was seen when fasting capillary glucose was <4.9 mmol/l (mean +/- SD 4.6 +/- 0.3 mmol/l) compared with 4.9-5.3 mmol/l or higher and when 2-h postprandial glucose was 5.9-6.4 mmol/l (6.2 +/- 0.2 mmol/l) or lower.


CONCLUSIONS
Glucose control in women with gestational diabetes mellitus treated with metformin and/or insulin is strongly related to outcomes. Obesity is not related to outcomes in this group. Targets for fasting and postprandial capillary glucose may need to be lower than currently recommended.
National Women's Hospital, Auckland City Hospital, Auckland, New Zealand. jrowan@internet.co.nz
Janet A
JA
Rowan
Wanzhen
W
Gao
William M
WM
Hague
Harold David
HD
McIntyre
D001724:Birth Weight; D048909:Diabetes Complications; D016640:Diabetes, Gestational / Q000188:drug therapy*; D005260:Female; D005865:Gestational Age; D005951:Glucose Tolerance Test; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007328:Insulin / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin