A RECENT meta-regression analysis offers important insights into the relationship between glycaemic control and pregnancy outcomes in women with diabetes, highlighting the clinical value of intensive glucose management during pregnancy. Despite long-standing assumptions that tighter control may reduce maternal and foetal risks, direct evidence linking improvements in blood glucose levels with better outcomes has remained limited. This study’s key finding is that reductions in fasting plasma glucose (FPG) and HbA1c are significantly associated with reduced risk of multiple adverse pregnancy outcomes.
Researchers systematically reviewed 62 eligible randomised controlled trials published between 1950 and April 2024, drawn from Embase and MEDLINE. Trials were included if they compared two levels of glucose control intensity in pregnant women with gestational, pregestational or overt diabetes. The analysis focused on the relationship between changes in four glycaemic control indicators (HbA1c, FPG, 2-hour postprandial glucose, and mean blood glucose) and 14 different adverse maternal or foetal outcomes. Statistical regression was used to examine dose-response relationships between glycaemic improvement and outcome risk.
Reductions in FPG were significantly associated with lower risk for 10 of the 14 pregnancy complications assessed. These included preeclampsia, neonatal hypoglycaemia, macrosomia and stillbirth. However, FPG reduction was not significantly linked with lower rates of caesarean section, small-for-gestational-age births, premature rupture of membranes, or congenital malformations. Notably, reductions in HbA1c were strongly associated with a decreased risk of caesarean delivery, with a correlation coefficient of r=0.67 (p<0.001). The relative risk for caesarean section was 0.63; 95% CI: 0.49–0.80 per 1% reduction in HbA1c, suggesting a clinically meaningful benefit.
This study confirms that improvements in glycaemic control achieved through more intensive glucose monitoring and management strategies can directly reduce the likelihood of many pregnancy complications in women with diabetes. The findings support a stronger emphasis on personalised glycaemic targets during antenatal care. However, the analysis is limited by its reliance on indirect comparisons across trials, variation in control targets, and a potential publication bias favouring studies reporting positive results. Future work should focus on refining optimal thresholds for intervention in different diabetes subtypes. Nonetheless, the evidence strengthens the case for vigilant glucose management as a key strategy in maternal-foetal medicine.
Reference
Kodoma S et al. Relationship Between Improvements in Glycemic Control and Risk of Pregnancy Complications in Patients With Diabetes Mellitus: Metaregression Analysis of Randomized Controlled Trials of Intensive Glucose Management. J Diabetes Res. 2025;DOI: 10.1155/jdr/3490884.
