Discussion
GDM
GDM, GESTATIONAL DIABETES MELLITUS
Overall, the results of our study suggest that the use of tighter glycemic targets, as used in the TARGET Trial, do not result in an alteration in maternal or infant cord plasma cytokine and adipokine concentrations when compared to women who were using less tight glycemic targets. Although the results do suggest there may be clinically important changes in maternal CRP and cholesterol concentrations and infant cord plasma C-peptide concentrations.Women using tighter glycemic targets who achieved ≥80% compliance with fasting, postprandial, or both fasting and postprandial glycemic targets had an altered maternal serum and cord plasma biomarker profile compared to women using less tight glycemic targets who achieved ≥80% compliance. Women who achieved compliance with tighter fasting glycemic targets had lower maternal leptin concentrations at 36 weeks’ gestation when adjusted for potential confounding factors, and their infants had lower C-peptide cord plasma concentrations compared with women who achieved compliance with the less tight glycemic targets. At 6 months after the birth when postprandial targets were achieved in the tighter targets group, women had a raised CRP and cholesterol concentrations and cord IGF concentrations were increased in their infants compared to those who achieved less tight postprandial targets. Women who achieved both fasting and postprandial targets in the tighter targets group had lower maternal leptin concentrations at 36 weeks’ gestation when adjusted for potential confounding factors. Infants of women achieving both tighter fasting and postprandial glycemic targets experienced a decrease in cord plasma C-peptide concentrations and there was a likely decrease in cord plasma leptin concentrations compared to those achieving less tight glycemic targets. These results indicate that significant changes do occur in maternal and infant biomarkers when high compliance with tighter glycemic targets can be achieved. The results of our study further contribute to the growing literature base surrounding the benefits and implications of tighter glycemic control in the management of gestational diabetes mellitus.A meta-analysisSeveral previous analyses have reported raised maternal serum CRP in women with GDM, particularly in the third trimester, compared with women without GDM.A systematic review of observational studies identified that maternal adiponectin concentrations were decreased in GDM compared with women without GDM.Although overall no difference was found in cord plasma leptin concentration between the glycemic target groups, reduced cord plasma leptin in infants of women who complied with tighter glycemic targets after adjustment for potential confounding factors is consistent with the results from other studies.The nested study within the ACHOIS Trial showed a decrease in cord plasma adiponectin in infants of women diagnosed with GDM, although there was no difference between infants of women treated for their GDM and infants of women who did not receive treatment.Our results suggest that tighter glycemic control results in reduced cord C-peptide concentrations. Several cohort studies have shown that cord C-peptide is raised in infants of women with GDM and suggest the insulin-secretory activity of an infant is related to maternal metabolic parameters, glycemic, and insulin homeostasis during pregnancy.Previous analyses have described increased cord plasma IGF concentrations in infants of women with GDM.There are several strengths to our study. These include the randomized controlled trial study design, which reduces the risk of confounding. By obtaining cardiometabolic marker concentrations during pregnancy, at birth, and postnatally, we were able to assess the impact of tight glycemic targets compared to less tight targets for women with GDM over time, not just around birth. In addition, we were better able to observe the true impact of optimal glycemic control on cardiometabolic markers by assessing compliance with glycemic control. Our study was limited by our sample size, particularly given the small number of women who achieved high compliance with the tighter targets and may have limited our ability to detect true differences in biomarker concentrations.