Very tight versus tight control for diabetes in pregnancy

Abstract

BACKGROUND: Pregnancies complicated by pre-existing insulin dependent diabetes are high risk for a number of poor pregnancy and neonatal outcomes. OBJECTIVES: The objective of this review was to assess the effects of very tight glycaemic control in established insulin dependence. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA: Randomised trials comparing very tight with tight control of diabetes in pregnancy. DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality and extracted data. MAIN RESULTS: Two trials involving 182 women were involved. The two trials were difficult to compare. Maternal hypoglycaemia was more common among women whose diabetic control was very tight compared to tight control (odds ratio 25.96, 95% confidence interval 4.91 to 137.26) based on one trial. There was no difference detected in perinatal outcome between the groups. AUTHORS' CONCLUSIONS: There appears to be no clear evidence of benefit from very tight glycaemic control for pregnant diabetic women. Since very strict control may have a substantial impact on lifestyle, this suggests caution in advising such a degree of control.