Poster Session 2
Rebecca Horgan, MD
Assistant Professor
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, VA, United States
Yara Hage Diab, MD
Research Fellow/Resident physician
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
Lauren A. Forbes, MD, MPH (she/her/hers)
Resident Physician
Eastern Virginia Medical School
Norfolk, Virginia, United States
Erkan Kalafat, MD, MSc
Associate Professor
Koc University Hospital
Istanbul, Istanbul, Turkey
Theresa Corbine
Advanced Practitioner
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
Margaret Mlynarczyk, MD, PhD
Associate Professor
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
George R. Saade, MD (he/him/his)
Professor and Chair, Associate Dean for Women's Health Obstetrics and Gynecology
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
Marwan Ma'Ayeh, MD
Assistant Professor
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
Continuous glucose monitor (CGM) is increasingly utilized to manage pregnant patients with type 2 diabetes (T2DM) and gestational diabetes (GDM), with target time in range (TIR) the main measure of glucose control. We sought to evaluate the independent contributions of initial TIR versus TIR trajectory during pregnancy on neonatal outcomes.
Study Design:
This retrospective cohort study included pregnant patients with T2DM or GDM using CGM for ⩾ 30 days from Jan 2020 to Dec 2022. Exclusion criteria were type 1 diabetes, multiple gestation, and unavailable delivery records. Target glucose values on CGM were defined as 63-140 mg/dL. Initial TIR was defined as mean TIR after 2 weeks of CGM use. The primary composite neonatal outcome was macrosomia, birth trauma, significant hyperbilirubinemia, stillbirth, or neonatal death. TIR values were modeled with mixed effect generalized additive models. TIR groups were formed using sample quartiles (Initial TIR: good, borderline, abnormal; TIR trajectory: worsened, stable and improved).
Results:
71 patients were included in the analysis. Initial TIR was abnormal in 17, borderline in 30, and good in 18, with the primary outcome occurring in 35%, 30%, and 17%, respectively. TIR trajectory worsened in 18, remained stable in 35, and improved in 12, with 28%, 29%, and 25%, respectively having the primary outcome. When initial TIR and trajectory were considered together, the primary outcome rates in patients with abnormal initial TIR were 25%, 50%, and 100% for improved, stable, and worsened TIR trajectory. For borderline initial TIR, rates were 0%, 30.4%, and 28.6%, respectively. For good initial TIR, rates were 12.5% and 20% for stable and worsened TIR. Initial TIR (aOR 0.26, 95% CI: 0.09-0.61) and TIR trajectories (aOR 0.45, 95% CI: 0.18-1.01) were independently associated with adverse outcomes after adjusting for diabetes type.
Conclusion:
Pregnant patients with T2DM and GDM should be counseled that poor initial TIR values on CGM is associated with increased risk of adverse neonatal outcomes, and improvement in TIR during pregnancy reduces this risk significantly.
