Glycemic Targets in Pregnancies Affected by Diabetes: Historical Perspective and Future Directions

Current Diabetes Reports

Volumn 15, Issue 1, 2015, Pages

  Hernandez, Teri L ^a,b,c  

^a UNIVERSITY OF COLORADO SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF COLORADO   (United States)

^c CHILDREN S HOSPITAL COLORADO   (United States)

Author keywords

CGMS; Fetal growth; Gestational diabetes; Glucometer; Glucose; Glucose targets; Glycemia; Lipids; Macrosomia; Metabolism; Pregnancy; Type 1 diabetes; Type 2 diabetes

Indexed keywords

FATTY ACID; GLIBENCLAMIDE; GLUCOSE; INSULIN; TRIACYLGLYCEROL; GLYCOSYLATED HEMOGLOBIN; HEMOGLOBIN A1C PROTEIN, HUMAN;

ABDOMINAL CIRCUMFERENCE; CIRCADIAN RHYTHM; CONGENITAL MALFORMATION; DIET THERAPY; DISEASE COURSE; FATTY ACID BLOOD LEVEL; FETUS DEATH; FETUS ECHOGRAPHY; FETUS GROWTH; FETUS OUTCOME; GLUCOSE BLOOD LEVEL; GLUCOSE INTOLERANCE; GLYCEMIC CONTROL; HUMAN; HYPERGLYCEMIA; HYPERTENSION; HYPOCALCEMIA; INSULIN DEFICIENCY; INSULIN DEPENDENT DIABETES MELLITUS; INSULIN RELEASE; INSULIN RESISTANCE; INSULIN TREATMENT; LARGE FOR GESTATIONAL AGE; MACROSOMIA; NEWBORN DEATH; NON INSULIN DEPENDENT DIABETES MELLITUS; OBESITY; OUTCOME ASSESSMENT; PHENOTYPE; PLACENTA INSUFFICIENCY; PREDICTIVE VALUE; PREGNANCY COMPLICATION; PREGNANCY DIABETES MELLITUS; PREGNANCY OUTCOME; PREGNANT WOMAN; PREMATURITY; REVIEW; SENTINEL EVENT; SMALL FOR DATE INFANT; VASCULAR DISEASE; ADULT; BIRTH WEIGHT; BLOOD; BODY MASS; COMPLICATION; FEMALE; FETAL MACROSOMIA; GLYCEMIC INDEX; HISTORY; META ANALYSIS (TOPIC); METABOLISM; NEWBORN; POSTPRANDIAL STATE; PREGNANCY; RANDOMIZED CONTROLLED TRIAL (TOPIC);

ADULT; BIRTH WEIGHT; BODY MASS INDEX; DIABETES MELLITUS, TYPE 1; DIABETES MELLITUS, TYPE 2; DIABETES, GESTATIONAL; FEMALE; FETAL MACROSOMIA; GLYCEMIC INDEX; HEMOGLOBIN A, GLYCOSYLATED; HISTORY, 19TH CENTURY; HISTORY, 20TH CENTURY; HISTORY, 21ST CENTURY; HUMANS; INFANT, NEWBORN; META-ANALYSIS AS TOPIC; POSTPRANDIAL PERIOD; PREGNANCY; PREGNANCY IN DIABETICS; RANDOMIZED CONTROLLED TRIALS AS TOPIC;

EID: 84911489236     PISSN: 15344827     EISSN: 15390829     Source Type: Journal    
DOI: 10.1007/s11892-014-0565-2     Document Type: Review

References (105)

1. Freinkel N. Banting Lecture 1980. Of pregnancy and progeny. Diabetes. 1980;29(12):1023–35.
2. Silverman BL, Metzger BE, Cho NH, Loeb CA. Impaired glucose tolerance in adolescent offspring of diabetic mothers relationship to fetal hyperinsulinism. Diabetes Care. 1995;18(5):611–7.
3. Vohr BR, McGarvey ST, Tucker R. Effects of maternal gestational diabetes on offspring adiposity at 4–7 years of age. Diabetes Care. 1999;22(8):1284–91.
4. Dabelea D, Hanson RL, Lindsay RS, Pettitt DJ, Imperatore G, Gabir MM, et al. Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: A study of discordant sibships. Diabetes. 2000;49(12):2208–11.
5. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: Association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005;115(3):e290–6.
6. Mestman JH. Historical notes on diabetes and pregnancy. Endocrinologist. 2002;12:224–42.
7. Fraser R. Diabetic control in pregnancy and intrauterine growth of the fetus. Br J Obstet Gynaecol. 1995;102(4):275–7.
8. Visser GHA, van Ballegooie E, Stuiter WJ. Macrosomia despite well-controlled diabetic pregnancy. Lancet. 1984;1:284–5.
9. Dandona P, Besterman HS, Freedman DB, Boag F, Taylor AM, Beckett AG. Macrosomia despite well-controlled diabetic pregnancy. Lancet. 1984;1(8379):737.
10. Combs CA, Gunderson E, Kitzmiller JL, Gavin LA, Main EK. Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy. Diabetes Care. 1992;15(10):1251–7.
11. Metzger BE, Phelps RL, Freinkel N, Navickas IA. Effects of gestational diabetes on diurnal profiles of plasma glucose, lipids, and individual amino acids. Diabetes Care. 1980;3(3):402–9.
12. Kalkhoff RK, Kissebah AH, Kim HJ. Carbohydrate and lipid metabolism during normal pregnancy: Relationship to gestational hormone action. Semin Perinatol. 1978;2(4):291–307.
13. Bleicher SJ, O’Sullivan JB, Freinkel N. Carbohydrate metabolism in pregnancy. V. The interrelations of glucose, insulin and free fatty acids in late pregnancy and post partum. N Engl J Med. 1964;271:866–72.
14. Kalkhoff RK, Kandaraki E, Morrow PG, Mitchell TH, Kelber S, Borkowf HI. Relationship between neonatal birth weight and maternal plasma amino acid profiles in lean and obese nondiabetic women and in type I diabetic pregnant women. Metabolism. 1988;37(3):234–9.
15. Schaefer-Graf UM, Graf K, Kulbacka I, Kjos SL, Dudenhausen J, Vetter K, et al. Maternal lipids as strong determinants of fetal environment and growth in pregnancies with gestational diabetes mellitus. Diabetes Care. 2008;31(9):1858–63.
16. Harmon KA, Gerard L, Jensen DR, Kealey EH, Hernandez TL, Reece MS, et al. Continuous glucose profiles in obese and normal-weight pregnant women on a controlled diet: Metabolic determinants of fetal growth. Diabetes Care. 2011;34(10):2198–204.
17. Olmos PR, Rigotti A, Busso D, Berkowitz L, Santos JL, Borzone GR, Poblete JA, Vera C, Belmar C, Goldenberg D, Samith B, Acosta AM, Escalona M, Niklitschek I, Mandiola JR, Mertens N. Maternal hypertriglyceridemia: A link between maternal overweight-obesity and macrosomia in gestational diabetes. Obesity (Silver Spring) 2014
18. Barrett HL, Dekker NM, McIntyre HD, Callaway LK. Normalizing metabolism in diabetic pregnancy: Is it time to target lipids. Diabetes Care. 2014;37(5):1484–93. This paper provides a thorough discussion of lipid metabolism in pregnancies complicated by diabetes. Because contemporary evidence supports a role for maternal lipids in fetal overgrowth, the authors address the potential for treating maternal dyslipidemia to improve perinatal outcomes.
19. Hernandez TL, Friedman JE, van Pelt RE, Barbour LA. Patterns of glycemia in normal pregnancy: Should the current therapeutic targets be challenged. Diabetes Care. 2011;34(7):1660–8. A systematic review of data spanning 50 years describing normoglycemia in pregnancy. Based on pooled analysis of weighted average glucose data, more aggressive therapeutic targets for pregnancies affected by diabetes are suggested for future clinical trials.
20. Hod M, Yogev Y. Goals of metabolic management of gestational diabetes: Is it all about the sugar? Diabetes Care. 2007;30 Suppl 2:S180–7.
21. Hare JW. Gestational diabetes mellitus. Levels of glycemia as management goals. Diabetes. 1991;40 Suppl 2:193–6.
22. Jovanovic L. American Diabetes Association’s Fourth International Workshop-Conference on Gestational Diabetes Mellitus: Summary and discussion. Therapeutic interventions. Diabetes Care. 1998;21 Suppl 2:B131–7.
23. American Diabetes Association Workshop-Conference on gestational diabetes: Summary and recommendations. Diabetes Care 1980;3(3):499–501
24. Proceedings of the Second International Workshop-Conference on Gestational Diabetes Mellitus. October 25–27, 1984, Chicago, Illinois. Diabetes 1985;34 Suppl 2:1–130
25. Metzger BE. Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes. 1991;40 Suppl 2:197–201.
26. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care. 1998;21 Suppl 2:B161–7.
27. Metzger BE, Buchanan TA, Coustan D, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30 Suppl 2:S251–60.
28. Tonyushkina K, Nichols JH. Glucose meters: A review of technical challenges to obtaining accurate results. J Diabetes Sci Technol. 2009;3(4):971–80.
29. D’Orazio P, Burnett RW, Fogh-Andersen N, Jacobs E, Kuwa K, Kulpmann WR, et al. Approved IFCC recommendation on reporting results for blood glucose (abbreviated). Clin Chem. 2005;51(9):1573–6.
30. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144(7):768–73.
31. O’Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964;13:278–85.
32. Metzger BE. 1990 overview of GDM. Accomplishments of the last decade—challenges for the future. Diabetes. 1991;40 Suppl 2:1–2.
33. Gabbe SG. Discussion of, "A rationale for omitting two-hour postprandial glucose determinations in gestational diabetes". Am J Obstet Gynecol. 1993;169(2 Pt 1):262–3.
34. O’Sullivan JB, Mahan CM, Charles D, Dandrow RV. Screening criteria for high-risk gestational diabetic patients. Am J Obstet Gynecol. 1973;116(7):895–900.
35. Gabbe SG. Discussion of, "A rationale for omitting two-hour postprandial glucose determinations in gestational diabetes". Am J Obstet Gynecol. 1993;169(2 Pt 1):262–3.
36. Persson B, Stangenberg M, Hansson U, Nordlander E. Gestational diabetes mellitus (GDM). Comparative evaluation of two treatment regimens, diet versus insulin and diet. Diabetes. 1985;34 Suppl 2:101–5.
37. Landon MB, Gabbe SG. Antepartum fetal surveillance in gestational diabetes mellitus. Diabetes. 1985;34 Suppl 2:50–4.
38. De HR. Monitoring the severity of metabolic disturbances and effectiveness of management of gestational diabetes mellitus. Diabetes. 1991;40 Suppl 2:157–60.
39. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2002;48(3):436–72.
40. Consensus statement on self-monitoring of blood glucose. Diabetes Care 1987;10(1):95–99.
41. Tallarigo L, Giampietro O, Penno G, Miccoli R, Gregori G, Navalesi R. Relation of glucose tolerance to complications of pregnancy in nondiabetic women. N Engl J Med. 1986;315(16):989–92.
42. Langer O, Mazze R. The relationship between large-for-gestational-age infants and glycemic control in women with gestational diabetes. Am J Obstet Gynecol. 1988;159(6):1478–83.
43. Langer O, Levy J, Brustman L, Anyaegbunam A, Merkatz R, Divon M. Glycemic control in gestational diabetes mellitus—how tight is tight enough: Small for gestational age versus large for gestational age? Am J Obstet Gynecol. 1989;161(3):646–53.
44. Gillmer MD, Beard RW, Brooke FM, Oakley NW. Carbohydrate metabolism in pregnancy. Part I. Diurnal plasma glucose profile in normal and diabetic women. Br Med J. 1975;3(5980):399–402.
45. Lewis SB, Wallin JD, Kuzuya H, Murray WK, Coustan DR, Daane TA, et al. Circadian variation of serum glucose, C-peptide immunoreactivity and free insulin normal and insulin-treated diabetic pregnant subjects. Diabetologia. 1976;12(4):343–50.
46. Cousins L, Rigg L, Hollingsworth D, Brink G, Aurand J, Yen SS. The 24-hour excursion and diurnal rhythm of glucose, insulin, and C-peptide in normal pregnancy. Am J Obstet Gynecol. 1980;136(4):483–8.
47. Phelps RL, Metzger BE, Freinkel N. Carbohydrate metabolism in pregnancy. XVII. Diurnal profiles of plasma glucose, insulin, free fatty acids, triglycerides, cholesterol, and individual amino acids in late normal pregnancy. Am J Obstet Gynecol. 1981;140(7):730–6.
48. McFarland MB, Langer O, Conway DL, Berkus MD. Dietary therapy for gestational diabetes: how long is long enough? Obstet Gynecol. 1999;93(6):978–82.
49. Jovanovic-Peterson L, Peterson CM, Reed GF, Metzger BE, Mills JL, Knopp RH, et al. Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development—Diabetes in Early Pregnancy Study. Am J Obstet Gynecol. 1991;164(1 Pt 1):103–11.
50. de Veciana M, Major CA, Morgan MA, Asrat T, Toohey JS, Lien JM, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med. 1995;333(19):1237–41.
51. Huddleston JF, Cramer MK, Vroon DH. A rationale for omitting two-hour postprandial glucose determinations in gestational diabetes. Am J Obstet Gynecol. 1993;169(2 Pt 1):257–62.
52. Parfitt VJ, Clark JD, Turner GM, Hartog M. Maternal postprandial blood glucose levels influence infant birth weight in diabetic pregnancy. Diabetes Res. 1992;19(3):133–5.
53. Thompson DM, Dansereau J, Creed M, Ridell L. Tight glucose control results in normal perinatal outcome in 150 patients with gestational diabetes. Obstet Gynecol. 1994;83(3):362–6.
54. Victor A. Normal blood sugar variation during pregnancy. Acta Obstet Gynecol Scand. 1974;53(1):37–40.
55. Buchanan TA, Kjos SL, Montoro MN, Wu PY, Madrilejo NG, Gonzalez M, et al. Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. Diabetes Care. 1994;17(4):275–83.
56. Willman SP, Leveno KJ, Guzick DS, Williams ML, Whalley PJ. Glucose threshold for macrosomia in pregnancy complicated by diabetes. Am J Obstet Gynecol. 1986;154(2):470–5.
57. Demarini S, Mimouni F, Tsang RC, Khoury J, Hertzberg V. Impact of metabolic control of diabetes during pregnancy on neonatal hypocalcemia: A randomized study. Obstet Gynecol. 1994;83(6):918–22.
58. Moses RG, Lucas EM, Knights S. Gestational diabetes mellitus. At what time should the postprandial glucose level be monitored? Aust N Z J Obstet Gynaecol. 1999;39(4):457–60.
59. Sivan E, Weisz B, Homko CJ, Reece EA, Schiff E. One or two hours postprandial glucose measurements: Are they the same? Am J Obstet Gynecol. 2001;185(3):604–7.
60. Weisz B, Shrim A, Homko CJ, Schiff E, Epstein GS, Sivan E. One hour versus two hours postprandial glucose measurement in gestational diabetes: A prospective study. J Perinatol. 2005;25(4):241–4.
61. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24):2477–86.
62. Parretti E, Mecacci F, Papini M, Cioni R, Carignani L, Mignosa M, et al. Third-trimester maternal glucose levels from diurnal profiles in nondiabetic pregnancies: Correlation with sonographic parameters of fetal growth. Diabetes Care. 2001;24(8):1319–23.
63. Chen R, Yogev Y, Ben Haroush A, Jovanovic L, Hod M, Phillip M. Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2003;14(4):256–60.
64. Ben Haroush A, Yogev Y, Chen R, Rosenn B, Hod M, Langer O. The postprandial glucose profile in the diabetic pregnancy. Am J Obstet Gynecol. 2004;191(2):576–81.
65. Yogev Y, Ben Haroush A, Chen R, Rosenn B, Hod M, Langer O. Diurnal glycemic profile in obese and normal weight nondiabetic pregnant women. Am J Obstet Gynecol. 2004;191(3):949–53.
66. Sermer M, Naylor CD, Gare DJ, Kenshole AB, Ritchie JW, Farine D, et al. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes. The Toronto Tri-Hospital Gestational Diabetes Project. Am J Obstet Gynecol. 1995;173(1):146–56.
67. Bonomo M, Corica D, Mion E, Goncalves D, Motta G, Merati R, et al. Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance: A randomized clinical trial. Diabet Med. 2005;22(11):1536–41.
68. Mello G, Parretti E, Mecacci F, La TP, Cioni R, Cianciulli D, et al. What degree of maternal metabolic control in women with type 1 diabetes is associated with normal body size and proportions in full-term infants? Diabetes Care. 2000;23(10):1494–8.
69. Howorka K, Pumprla J, Gabriel M, Feiks A, Schlusche C, Nowotny C, et al. Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out-patient education adapted for pregnancy. Diabet Med. 2001;18(12):965–72.
70. Kjos SL, Schaefer-Graf U, Sardesi S, Peters RK, Buley A, Xiang AH, et al. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care. 2001;24(11):1904–10.
71. Schaefer-Graf UM, Kjos SL, Fauzan OH, Buhling KJ, Siebert G, Buhrer C, et al. A randomized trial evaluating a predominantly fetal growth-based strategy to guide management of gestational diabetes in Caucasian women. Diabetes Care. 2004;27(2):297–302.
72. Bonomo M, Cetin I, Pisoni MP, Faden D, Mion E, Taricco E, et al. Flexible treatment of gestational diabetes modulated on ultrasound evaluation of intrauterine growth: A controlled randomized clinical trial. Diabetes Metab. 2004;30(3):237–44.
73. Kjos SL, Schaefer-Graf UM. Modified therapy for gestational diabetes using high-risk and low-risk fetal abdominal circumference growth to select strict versus relaxed maternal glycemic targets. Diabetes Care. 2007;30 Suppl 2:S200–5.
74. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002.
75. Porter H, Lookinland S, Belfort MA. Evaluation of a new real-time blood continuous glucose monitoring system in pregnant women without gestational diabetes. A pilot study. J Perinat Neonatal Nurs. 2004;18(2):93–102.
76. Cypryk K, Pertynska-Marczewska M, Szymczak W, Wilcynski J, Lewinski A. Evaluation of metabolic control in women with gestational diabetes mellitus by the continuous glucose monitoring system: A pilot study. Endocr Pract. 2006;12(3):245–50.
77. Siegmund T, Rad NT, Ritterath C, Siebert G, Henrich W, Buhling KJ. Longitudinal changes in the continuous glucose profile measured by the CGMS in healthy pregnant women and determination of cut-off values. Eur J Obstet Gynecol Reprod Biol. 2008;139(1):46–52.
78. Riskin-Mashiah S, Damti A, Younes G, Auslander R. Normal fasting plasma glucose levels during pregnancy: A hospital-based study. J Perinat Med. 2011;39(2):209–11.
79. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82.
80. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361(14):1339–48.
81. Prutsky GJ, Domecq JP, Wang Z, Carranza Leon BG, Elraiyah T, Nabhan M, et al. Glucose targets in pregnant women with diabetes: A systematic review and meta-analysis. J Clin Endocrinol Metab. 2013;98(11):4319–24. This manuscript highlights the very low quality of evidence supporting glucose targets in pregnancies affected by diabetes in terms of their association with maternal and fetal outcomes. The study is a systematic review and meta-analysis of glucose targets in pregnancy (34 studies, 9433 women) commissioned by the Endocrine Society.
82. Standards of medical care in diabetes–2014. Diabetes Care 2014;37 Suppl 1:S14-S80.
83. American College of Obstetricians and Gynecologists. ACOG practice bulletin: gestational diabetes mellitus. Washington, DC: American College of Obstetricians and Gynecologists; 2013. Report No.: 137.
84. Blumer I, Hadar E, Hadden DR, Jovanovic L, Mestman JH, Murad MH, et al. Diabetes and pregnancy: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(11):4227–49.
85. Nankervis A, McIntyre HD, Moses RG et al. ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia (May 2013: Version 2). Australian Diabetes in Pregnancy Society 2013;Available at: URL: www.adips.org/information-for-health-care-providers-approved.asp.
86. Thompson D, Berger H, Feig D, Gagnon R, Kader T, Keely E, et al. Diabetes and pregnancy. Can J Diabetes. 2013;37 Suppl 1:S168–83.
87. National Institute for Health and Care Excellence (NICE). Diabetes in pregnancy: Management of diabetes and its complications from pre-conception to the postnatal period. 2008. Report No.: CG63.
88. Nankervis A, McIntyre HD, Moses RG, Ross GP, Callaway LK. Testing for gestational diabetes mellitus in Australia. Diabetes Care. 2013;36(5):e64.
89. World Health Organization. Diagnostic criteria and classification of hyperglycemia first detected in pregnancy. 2013. Report No.: WHO/NMH/MND/13.2.
90. Metzger BE, Buchanan TA, Coustan D, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30 Suppl 2:S251–60.
91. Ryan EA. Diagnosing gestational diabetes. Diabetologia. 2011;54(3):480–6. This paper provides a thorough discussion of how the new diagnostic criteria for gestational diabetes, based on a 1.75-fold increased risk for delivering a large-for-gestational age infant, were derived from the Hyperglycemia and Adverse Pregnancy Outcomes trial. Using data from the trial, the author points out that maternal BMI had a greater influence on the risk for large for gestational age than glucose, and urges more discussion of the targets before implementation.
92. Pedersen J. Weight and length at birth of infants of diabetic mothers. Acta Endocrinol (Copenh). 1954;16(4):330–42.
93. Merriam-Webster. Merriam-Webster on-line dictionary and thesaurus. Merriam-Webster, Inc 2014;Available at: URL: www.merriam-webster.com. Accessed July 26, 14 A.D.
94. Mainland D. Remarks on clinical "norms". Clin Chem. 1971;17(4):267–74.
95. Rey E, Attie C, Bonin A. The effects of first-trimester diabetes control on the incidence of macrosomia. Am J Obstet Gynecol. 1999;181(1):202–6.
96. Henriksen T. The macrosomic fetus: A challenge in current obstetrics. Acta Obstet Gynecol Scand. 2008;87(2):134–45.
97. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Int J Gynaecol Obstet 2002;78(1):69–77.
98. Sacks DA, Chen W, Greenspoon JS, Wolde-Tsadik G. Should the same glucose values be targeted for type 1 as for type 2 diabetics in pregnancy? Am J Obstet Gynecol. 1997;177(5):1113–9.
99. Langer O. Glycemic targets for the optimal treatment of GDM. Clin Obstet Gynecol. 2013;56(4):788–802.
100. Nielsen LR, Pedersen-Bjergaard U, Thorsteinsson B, Johansen M, Damm P, Mathiesen ER. Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care. 2008;31(1):9–14.
101. Robertson H, Pearson DW, Gold AE. Severe hypoglycaemia during pregnancy in women with type 1 diabetes is common and planning pregnancy does not decrease the risk. Diabet Med. 2009;26(8):824–6.
102. Heller S, Damm P, Mersebach H, Skjoth TV, Kaaja R, Hod M, et al. Hypoglycemia in type 1 diabetic pregnancy: Role of preconception insulin aspart treatment in a randomized study. Diabetes Care. 2010;33(3):473–7.
103. Barbour LA. Changing perspectives in pre-existing diabetes in pregnancy and gestational diabetes: Maternal and infant short- and long-term outcomes. Curr Opin Endocrinol Diabetes Obes. 2014;21:257–63.
104. Schauer IE, Snell-Bergeon JK, Bergman BC, Maahs DM, Kretowski A, Eckel RH, et al. Insulin resistance, defective insulin-mediated fatty acid suppression, and coronary artery calcification in subjects with and without type 1 diabetes: the CACTI study. Diabetes. 2011;60(1):306–14.
105. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005;115(3):485–91.