Affiliation: | 1. Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands;2. Department of Obstetrics and Gynecology, WKZ, Utrecht, The Netherlands;3. Department of Endocrinology, University Medical Centre Utrecht, Utrecht, The Netherlands;4. Department of Obstetrics and Gynecology, Amersfoort, The Netherlands;5. Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Abderdeen, UK;6. Department of Obstetrics and Gynecology, Erasmus University, Rotterdam, The Netherlands;7. Amsterdam UMC location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam, The Netherlands Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, The Netherlands;8. Amsterdam UMC location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam, The Netherlands;9. Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands |
Abstract: | Aim To investigate the association between continuous glucose monitoring (CGM) metrics and perinatal outcomes in insulin-treated diabetes mellitus in pregnancy. Materials and Methods In a post-hoc analysis of the GlucoMOMS randomized controlled trial, we investigated the association between the metrics of an offline, intermittent CGM, glycated haemoglobin (HbA1c) and perinatal outcomes per trimester in different types of diabetes (type 1, 2 or insulin-treated gestational diabetes mellitus [GDM]). Data were analysed using multivariable binary logistic regression. Outcomes of interest were neonatal hypoglycaemia, pre-eclampsia, preterm birth, large for gestational age (LGA) and Neonatal Intensive Care Unit (NICU) admission. The glucose target range was defined as 3.5–7.8 mmol/L (63–140 mg/dL). Results Of the 147 participants (N = 50 type 1 diabetes, N = 94 type 2 diabetes/insulin-treated GDM) randomized to the CGM group of the GlucoMOMS trial, 115 participants had CGM metrics available and were included in the current study. We found that, in pregnancies with type 1 diabetes, a higher second trimester mean glucose was associated with LGA (odds ratio 2.6 [95% confidence interval 1.1–6.2]). In type 2 and insulin-treated gestational diabetes, an increased area under the curve above limit was associated with LGA (odds ratio 10.0 [95% confidence interval 1.4–72.8]). None of the CGM metrics were associated with neonatal hypoglycaemia, pre-eclampsia, shoulder dystocia, preterm birth and NICU admission rates for pregnancies complicated by any type of diabetes. Conclusion In this study, in type 2 diabetes or insulin-treated GDM, the glucose increased area under the curve above limit was associated with increased LGA. In type 1 diabetes, the mean glucose was the major determinant of LGA. Our study found no evidence that other CGM metrics determined adverse pregnancy outcomes. |