Observational studies have shown an association of poor glycemic control (GC) with various adverse pregnancy outcomes in patients with diabetes mellitus. To examine whether improving GC reduces risk of maternal/fetal complications, we did a meta-analysis of the quantitative relationship between reductions in glucose levels and individual complication risks. MEDLINE and EMBASE were used to identify randomized controlled trials of the effect of intensified glucose management (i.e., glucose monitoring and/or strict glycemic goals, additional glucose-lowering drugs) on both antepartum glucose levels and incidence of any maternal/fetal complication. Fifty-two eligible trials were retrieved from 2724 articles published until Aug.31, 2022. Focusing on cesarean section (CS) and macrosomia (including large for gestational age if data were unavailable), which are frequent complications, meta-regression analyses indicated that a 1% reduction in HbA1c resulted in a 45% reduction in CS (r=0.59, p=0.002) and a 72% reduction in macrosomia (r=0.43, p=0.005). The intercept (i.e., relative risk at 0 of HbA1c reduction) was almost 1 (1.05 (p=0.46) for CS; 1.02 (p=0.89) for macrosomia) (Figure). In trials of patients with only gestational diabetes, results were unchanged. We conclude that preventing CS and macrosomia depended on the extent to which antenatal cares improved GC.
S.Kodama: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. N.Yagyuda: None. T.Yamada: None. K.Nishijima: None. K.Yoshihara: None. K.Fujihara: None. Y.Yachi: None. M.Iwanaga: None. K.Kato: None.
