What is the optimal blood glucose range throughout the day during pregnancy?

From the Guidelines

During pregnancy, the optimal blood sugar range is generally fasting plasma glucose <95 mg/dL and either 1-h postprandial glucose <140 mg/dL or 2-h postprandial glucose <120 mg/dL, as recommended by the most recent guidelines 1. These target ranges are crucial for minimizing the risks of complications such as macrosomia, preeclampsia, and neonatal hypoglycemia. The importance of maintaining these target blood sugar levels cannot be overstated, as pregnancy naturally induces some level of insulin resistance due to the placenta's production of hormones that can interfere with insulin's action, potentially leading to higher blood sugar levels. Key points to consider include:

• Fasting blood glucose should be below 95 mg/dL.
• One-hour postprandial glucose should be less than 140 mg/dL, or two-hour postprandial glucose should be less than 120 mg/dL.
• Continuous glucose monitoring (CGM) can be beneficial for achieving glycemic goals, especially in type 1 diabetes and pregnancy, as evidenced by studies like the Continuous Glucose Monitoring in Pregnant Women With Type 1 Diabetes Trial (CONCEPTT) 1. Women with pre-existing diabetes or those who develop gestational diabetes should monitor their blood sugar levels regularly, typically 4-7 times daily, using a glucose meter. This monitoring should include checking blood sugar first thing in the morning (fasting) and either one or two hours after starting each meal. If blood sugar levels consistently fall outside the recommended ranges despite dietary changes and exercise, healthcare providers may recommend insulin or other medications like metformin to help control glucose levels. It's essential to remember that individual targets may vary based on specific health circumstances, so it's crucial to follow a healthcare provider's personalized recommendations. The goal for A1C during pregnancy is <6% (<42 mmol/mol) if this can be achieved without significant hypoglycemia, but it may be relaxed to <7% (<53 mmol/mol) if necessary to prevent hypoglycemia, as suggested by recent guidelines 1.

From the Research

Optimal Blood Sugar Range Throughout the Day During Pregnancy

The optimal blood sugar range throughout the day during pregnancy is crucial for maintaining the health of both the mother and the fetus.

• Fasting blood glucose levels should be between 60-95 mg/dL 2, 3, 4
• 2-hour postprandial glucose levels should be less than 120-140 mg/dL 2, 3, 4
• Hemoglobin A1c (HbA1c) levels should be less than 6.5% 2, 3, 4

Importance of Blood Sugar Control

Controlling blood sugar levels is essential for preventing complications during pregnancy, such as:

• Hypertensive disorders of pregnancy 5
• Pre-eclampsia 5
• Caesarean section 5
• Neonatal hypoglycemia 5
• Macrosomia 3
• Neonatal jaundice 3

Treatment Options

Treatment options for gestational diabetes mellitus (GDM) include:

• Insulin therapy 6, 5, 2, 3, 4
• Metformin therapy 2, 3, 4
• Combination of insulin and metformin 2, 3, 4

Benefits of Combination Therapy

Combination therapy with insulin and metformin has been shown to:

• Improve blood glucose control 2, 3, 4
• Reduce the risk of adverse pregnancy outcomes 2, 3, 4
• Mitigate renal injury 4
• Improve pregnancy outcome 4