Research Summary
Tighter glycaemic targets may reduce serious infant morbidity
Moderate confidence
Low bias
Last updated June 15, 2026Key Takeaway:
This study evaluated the impact of tighter glycaemic control in women with gestational diabetes. It found a reduction in serious health outcomes for infants but an increase in serious maternal health outcomes.
Study at a Glance
Participants
Intervention
Tighter glycemic control, Less tight glycemic control
Outcomes
Large for gestational age, Composite serious health outcome for the infant, Serious maternal health outcome, Pharmacological treatment requirement
Funding
Non-Industry Sponsored
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Main Effects
The rate of large for gestational age was similar between groups (14.7% vs 15.1%; P = 0.839).
The composite serious health outcome for infants was reduced in the tighter group (1.3% vs 2.6%; P = 0.032).
Shorter length of stay in intensive care was observed in the tighter group (P = 0.041).
Serious maternal health outcomes increased in the tighter group (5.9% vs 3.0%; P = 0.020).
Evidence Summary
| Intervention | Outcome | Measured Change | Study Effect |
|---|---|---|---|
 Less tight glycemic control (Procedures) |  Composite cardiovascular events (CV death, MI, stroke, HF hospitalization) (Clinical Outcomes) | Decrease | Strong |
Less tight glycemic control (Procedures) | Serious maternal health outcome (Clinical Outcomes) | Increase | Unclear |
Less tight glycemic control (Procedures) |  Serious perinatal adverse events (Safety) | No Change | Unclear |
Tighter glycemic control (Procedures) | Composite cardiovascular events (CV death, MI, stroke, HF hospitalization) (Clinical Outcomes) | Decrease | Strong |
Tighter glycemic control (Procedures) | Serious maternal health outcome (Clinical Outcomes) | Increase | Unclear |
Tighter glycemic control (Procedures) | Serious perinatal adverse events (Safety) | No Change | Unclear |
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Evidence Suggest
- Tighter glycaemic control reduced serious health outcomes for infants (1.3% vs 2.6%; P = 0.032).
- Increased serious maternal health outcomes in the tighter group (5.9% vs 3.0%; P = 0.020).
- More women required pharmacological treatment with tighter targets (67.9% vs 58.5%; P = 0.047).
Who this applies to
- Women diagnosed with gestational diabetes.
- Pregnant women requiring glycaemic management.
Keep in Mind
- Results may not apply to all populations with gestational diabetes.
- The study did not account for all potential confounding variables.
- Further research is needed to explore long-term outcomes for mothers and infants.
Between the Lines
- The study's design may limit generalizability to broader populations.
- Potential confounding factors were not fully controlled.
- The sample size may affect the robustness of the findings.
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Journal Reference
Caroline AC, Deborah S, Ruth H, et al. Tighter Glycaemic Targets in Women with Gestational Diabetes: A Stepped-Wedge Cluster-Randomised Trial. PLOS Medicine. 2022;19(9):e1004087. doi:10.1371/journal.pmed.1004087
Connected Evidence
Discover how this study fits into the broader diabetes evidence landscape.
This study contributes to evidence on Less tight glycemic control and Cardiovascular Outcomes, Tighter glycemic control and Cardiovascular Outcomes.
Related evidence relationships
Explore in Evidence ArchiveThis study contributes to the evidence on the following intervention–outcome relationships.
Included in these evidence collections
Curated evidence collections and hubs this study is part of.
Cardiovascular Outcomes Evidence Hub
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1 studies
outcome_hubMeasures Cardiovascular Outcomes as a key outcome.
Less tight glycemic control Evidence Hub
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intervention_hubContributes to Less tight glycemic control evidence base.
Tighter glycemic control Evidence Hub
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intervention_hubContributes to Tighter glycemic control evidence base.
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Questions this evidence helps answer
Key clinical and research questions this study contributes to.
Does less tight glycemic control improve Composite cardiovascular events (CV death, MI, stroke, HF hospitalization)?
Based on connected evidence for Less tight glycemic control and Composite cardiovascular events (CV death, MI, stroke, HF hospitalization).
Does tighter glycemic control affect Composite cardiovascular events (CV death, MI, stroke, HF hospitalization) in people with diabetes?
Exploring evidence on Tighter glycemic control and Composite cardiovascular events (CV death, MI, stroke, HF hospitalization) outcomes.
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