(682) Postpartum glycemic trends among people with gestational diabetes using continuous glucose monitoring

Objective: The immediate changes in glycemia following delivery have not been well characterized among pregnant people with gestational diabetes mellitus (GDM), particularly considering the heterogeneity of GDM. Therefore, we sought to characterize postpartum glycemia using continuous glucose monitoring (CGM) data and explore postpartum glycemic trends among people with GDM by GDM and delivery characteristics.

Study Design: This was a secondary analysis of pregnant people with GDM randomized to using CGM versus capillary blood glucose for management of GDM. Our primary outcome was mean glucose by hour from delivery through 48 hours after delivery. We stratified by GDM type, mode of delivery and time in range during pregnancy (≥90%, 70-140) to determine influence on glycemia postpartum.

Results: Of the 111 participants in the original analysis, 79 participants with postpartum data were included in this analysis, 22.8% with A1GDM and 77.2% with A2GDM. In the overall cohort, glucose values had a slight downward trend over the first 48 hours post-delivery (Figure 1a). Upon stratification, participants with A1GDM had lower glucose by 48 hours compared to those with A2GDM (Figure 1b), as did participants with high time-in-range compared with lower time-in-range during pregnancy (Figure 1c). After cesarean delivery, participants initially had lower glucose values compared to vaginal delivery, which then rose after the first 24 hours prior to returning to baseline by 48 hours (Figure 1d).

Conclusion: In this study, we found that postpartum glycemia had a downward trend after delivery and was impacted by multiple pregnancy and delivery characteristics. These results highlight the physiologic changes that are occurring in regard to glycemia during the postpartum period. Future studies should assess whether differences in postpartum glycemic parameters are associated with clinically relevant outcomes.