• Philippa Middleton, Caroline A Crowther, Lucy Simmonds, and Peter Muller.
• ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, Australia, 5006.
• Cochrane Db Syst Rev. 2010 Sep 8 (9): CD008540.

BackgroundThe optimal glycaemic control target in pregnant women with pre-existing diabetes is unclear, although there is a clear link between high glucose concentrations and adverse birth outcomes.ObjectivesTo assess the effects of different intensities of glycaemic control in pregnant women with pre-existing type 1 or type 2 diabetes.Search StrategyWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 May 2010).Selection CriteriaWe included randomised controlled trials comparing different glycaemic control targets in pregnant women with pre-existing diabetes.Data Collection And AnalysisTwo review authors assessed trial eligibility and risk of bias, and extracted data.Main ResultsWe included three trials all in women with type 1 diabetes (223 women and babies), and all with a high risk of bias. Two trials compared very tight (3.33 to 5.0 mmol/L fasting blood glucose (FBG)) with tight-moderate (4.45 to 6.38) glycaemic control targets, with one trial of 22 babies reporting no perinatal deaths or serious perinatal morbidity. In the same trial, there were two birth defects in the very tight and none in the tight-moderate group with no significant differences in caesarean section between groups (risk ratio 0.92, 95% confidence interval (CI) 0.49 to 1.73). In these two trials glycaemic control was not significantly different between the very tight and tight-moderate groups by the third trimester, although one trial of 22 women found significantly less maternal hypoglycaemia in the tight-moderate group.In a trial of 60 women and babies comparing tight (Authors' ConclusionsIn a very limited body of evidence, few differences in outcomes were seen between very tight and tight-moderate glycaemic control targets in pregnant women with pre-existing type 1 diabetes, including actual glycaemic control achieved. There is evidence of harm (increased pre-eclampsia, caesareans and birthweights greater than 90th centile) for 'loose' control (FBG above 7 mmol/L). Future trials comparing interventions, rather than glycaemic control targets, may be more feasible particularly for pregnant women with type 2 diabetes.

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