To assess the association between active glycemic management and large for gestational age (LGA) neonates and cesarean delivery (CD) among pregnant women with impaired fasting glucose (IFG). Retrospective cohort study using electronic health record data of women with IFG who delivered at Kaiser Permanente Northern California from 2012-2017. IFG was defined as isolated fasting glucose ≥95 mg/dL. Women with gestational diabetes (GDM) or in whom GDM could not be ruled out were excluded. Baseline and treatment characteristics, and pregnancy outcomes were compared among women with IFG who participated in telephonic home glucose monitoring and glycemic management through a centralized standardized program (participants) with those who did not participate (non-participants). The relative risks (RR) of perinatal complications associated with participation versus non-participation were estimated with Poisson regression models. We identified 1,584 women meeting inclusion criteria, of whom 1,151 (72.7%) were participants and 433 (27.3%) were non-participants. There were no differences between groups in baseline characteristics or comorbidities, except for higher mean levels of fasting glucose (FG) at the time of IFG diagnosis in participants than in non-participants (98.9 mg/dL vs 98.0 mg/dL, p=0.01). Participants received hypoglycemic medications more frequently than non-participants (68.2% vs 0.9%, p<0.01). The rate of LGA was significantly lower in participants compared with non-participants (19.1% vs 25.0%, p=0.01). After adjusting for age, race/ethnicity, education, body mass index, and level of FG impairment, the RR for LGA for participants compared with non-participants was 0.68, 95% CI: 0.55-0.84. The risk of cesarean delivery did not differ significantly by participation status, in unadjusted or adjusted analyses. Active standardized glycemic management was associated with a decreased risk of LGA for women with IFG. This finding supports an active glycemic management strategy for patients with IFG during pregnancy to reduce the risk of LGA, similar to GDM management.