by Lisa J. Douglas, Greg D. Gamble, Jane E. Harding, Deborah Samuel, Carl L. Eagleton, Jane M. Alsweiler, Trecia A. Wouldes, Benjamin Thompson, Christopher J. D. McKinlay, Caroline A. Crowther
Background
Optimal glycaemic targets for women with gestational diabetes mellitus (GDM) are unclear. The aim of this study was to compare maternal and child health 4.5 years after women with GDM had been randomised to use tight or less tight targets for glycaemic control during their pregnancy.
Methods and findings
The TARGET trial was a stepped-wedge, cluster-randomised trial conducted between May 29, 2015 and November 7, 2017 at 10 hospitals in New Zealand. All hospitals were initially allocated to use less tight glycaemic treatment targets (fasting plasma glucose (FPG) P = 0.080)). Child BMI z-scores were similar between groups (mean z-score 0.83 SD 1.72 versus 0.75 SD 1.48; adjMD 0.12 (95% CI [−0.24, 0.48]; P = 0.498)), although children in the tight glycaemic group were taller (107.8 cm SD 5.5 versus 106.0 cm SD 5.5; adjMD 1.83 (95% CI [0.58, 3.08]; P = 0.004)). Worse child outcomes were seen in the tight glycaemic group for coordination difficulties (31/109, 28.4% versus 21/118, 17.8%; adjusted relative risk (adjRR) 1.66 (95% CI [1.01, 2.73]; P = 0.044)), behaviour (likely on the autism spectrum 10/108, 9.3% versus 3/117, 2.6%; adjRR 3.67 (95% CI [1.02, 13.23]; P = 0.047)) and total difficulties scores from the strengths and difficulties questionnaire (mean score 8.4 SD 5.1 versus 6.8 SD 4.5; adjMD 1.75 (95% CI [0.51, 3.00]; P = 0.006)). The main limitation was the use of questionnaires rather than health professional assessments for some of the outcomes.
Conclusions
Tight compared to less tight glycaemic targets in women with GDM during pregnancy did not result in lower maternal HbA1c or lower child BMI z-scores 4.5 years later, and may be associated with adverse child motor and behavioural outcomes.