Endocrine Abstracts

Introduction: Gestational diabetes mellitus (GDM) is associated with an increase risk of neonatal and maternal complications. Continuous glucose monitoring (CGM) detects glycemic patterns, which could help predict the development of maternal-fetal complications.

Objective: To analyze the different glycemic patterns obtained with CGM and to correlate them with the appearance of maternal-fetal complications in GDM.

Methods: Women with GDM at 26–32 gestational weeks were allocated a 6-day CGM system (Ipro^TM2) right after diagnosis in an observational prospective study. The following parameters were analyzed by CGM: percentage of time that glucose is above or below range before and after breakfast, lunch, dinner and night. Glucose targets: before meals 70–95 mg/dL, after meals 70–140 mg/dL and night 70–120 mg/dL. Multivariable binary logistic regression was performed to identify independent risk factors associated with both neonatal and maternal outcomes. Value of P 0.05 were considered statistically significant.

Results: n=87. Maternal age 33±4.26 years (>35 years=39%). Pregestational body mass index 26.2±4.7kg/m² (>30 kg/m²=22.1%). Insulin treatment 23.4%. Maternal and neonatal outcomes: caesarean 28.6%, macrosomia13%, large gestational age (LGA) 8.2%, small gestational age 6.5%, neonatal hypoglycemia 22.1%, neonatal hyperbilirubinemia 7.8%, need for supplemental oxygen in the neonate 7.8%. Glucose time above and below range (%): before breakfast: >95=25.75%, 70–95=66.79% and <70=7.36%; after breakfast:>140=18.49%, 70–140=80.71% and <70=0.77%; before lunch: >95=20.43%, 70–95=70.16% and <70=90.48%; after lunch: >140=11.08%, 70–140=85.87% and <70=3.18%; before dinner:>95=35.81%, 70–95=58.55% and <70=5.47%; after dinner: >140=8.18%, 70–140=88.89 and <70=2.94%; night: >120=7.84%, 71–120=81.79% and <70=90.40%. Multivariate binary logistic regression: Glucose time above range after lunch was an independent factor for macrosomia (Odds ratio 1.041, 95% confidence interval [1.002–1.081]; P value 0.035) and LGA (Odds ratio 1052, 95% confidence interval [1.012–1.094]; P value 0.010). It was not found another independent risk factor for maternal or neonatal outcomes.

Conclusions: There is a correlation between hyperglycemia after lunch at diagnosis of GDM and macrosomia and LGA, although a predominance of preprandial hyperglycemia is observed, especially before dinner. The use of CGM could help identify those patients with higher risk of maternal-fetal complications. However, further studies with a larger number of patients are required.