Continuous glucose monitoring metrics and pregnancy outcomes in insulin‐treated diabetes: A post‐hoc analysis of the GlucoMOMS trial

Abstract

AimTo investigate the association between continuous glucose monitoring (CGM) metrics and perinatal outcomes in insulin‐treated diabetes mellitus in pregnancy.Materials and MethodsIn 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).ResultsOf 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.ConclusionIn 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.

Effect of artificial pancreas system use on glycaemic control among pregnant women with type 1 diabetes mellitus: A meta‐analysis of randomized controlled trials

“…[35][36][37][38] However, MBG, rather than any other crucial continuous glucose monitoring (CGM) metrics, was the major determinant of large for gestational age (LGA) infants in women with T1DM in a post hoc analysis of the GlucoMOMS trial. 39 This inconsistent result might be attributed to the retrospective CGM use, poor glycaemic control, and relatively small sample size in the GlucoMOMS trial. Thus, it is recommended to optimize glycaemic control, including boosting TIR, while lowering TAR, TBR and glycaemic variability measures across pregnancy to improve pregnancy outcomes.…”

Continuous Glucose Monitoring Metrics for Pregnancies Complicated by Diabetes: Critical Appraisal of Current Evidence

“…Mean glucose has emerged as a significant predictor of neonatal outcomes in multiple studies (Table 2). 10,13,15,[19][20][21][22][23] Higher CGM mean glucose in the second and third trimesters is associated with LGA in T1D and GDM, 1,10,13,15 and may be the glycemic marker with the strongest association with LGA. 13 Surprisingly, first trimester mean glucose was found to be significantly lower in the first trimester but higher in the second and third trimesters in individuals who delivered LGA infants.…”

“…Most studies assessing the impact of CGM use on neonatal and maternal outcomes as well as the relationships between CGM metrics and pregnancy outcomes included women with T1D, alone or less commonly in combination with T2D and/ or insulin-treated GDM (Table 2). 2,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]25 Notably, the major trials evaluating impact of CGM use on pregnancy outcomes evaluated CGM as adjunctive therapy to BGM, and these trials did not compare use of CGM alone to standard care (BGM). Given the need for extremely tight glucose control in pregnancy, it may still be beneficial to confirm CGM measurements with BGM measurements for actionable events (eg, need to bolus insulin or treat hypoglycemia).…”