(469) Adverse Pregnancy Outcomes in People with Type 2 Diabetes Mellitus Utilizing Continuous Glucose Monitoring

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: In recent years, continuous glucose monitoring (CGM) has become available for people with type 2 diabetes (T2DM) or gestational diabetes (GDM) during pregnancy. However, the recommended time in range (TIR, blood glucose 70-140 mg/dL) and correlation of TIR with adverse pregnancy outcomes in people with T2DM or GDM is not well known. Our aim was to compare maternal and neonatal outcomes in pregnant people with T2DM or GDM with average CGM TIR ≥70% vs < 70% during pregnancy.

Study Design:

We conducted a retrospective cohort study of all individuals using CGM during pregnancy from January 2017 to June 2022 at a quaternary center. Individuals with Type 1 diabetes, or those with missing CGM or delivery data were excluded. Primary composite neonatal outcome included any of the following: large for gestational age, NICU admission, need for IV glucose, respiratory support or neonatal death. Secondary outcomes included other maternal and neonatal outcomes. Regression models were used to estimate adjusted odds ratio (aOR) and 95% confidence intervals (CI).

Results: During the study period, of 141 individuals with diabetes who utilized CGM during pregnancy, 65 (46%) met inclusion criteria. Excluded were Type 1(n= 57) diabetes, missing CGM data (n=5), missing delivery data (n=14). Of the study population, 28 (43%) had TIR < 70% and 37 (57%) had TIR ≥ 70%. Individuals with TIR < 70% had a higher mean glucose reading (151 vs 109, p< 0.001), and were less likely to have GDM (Table 1). The primary composite outcome occurred more frequently in neonates of individuals with TIR < 70% (71.4% vs 37.8%, aOR 4.8, 95% CI 1.6, 15.7). Furthermore, people with TIR < 70% were more likely to have hypertensive disorders (42.9% versus 16.2%, OR 3.9, 95% CI 1.3, 13.0), have a preterm delivery (54% vs 27%, OR 3.1, 95% CI 1.1, 9.1), and have cesarean delivery (96.4% vs 51.4%, OR 4.6, 95% CI 2.2, 15.1; Table 2) compared to those with TIR≥70%.

Conclusion: Among people with T2DM or GDM who utilized CGM during pregnancy, 4 out 10 individuals had TIR < 70% and they are at significantly higher risk of adverse neonatal and maternal outcomes.

Primary & Presenting Author(s)

Ghamar Bitar, MD
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States

Coauthor(s)

JC
John Cornthwaite, PhD
Rice University
Houston, Texas, United States
JA
Joy A. Ashby Cornthwaite, RD, CDE, MS
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Sarah Nazeer, MD (she/her/hers)
Maternal-Fetal Medicine Fellow
Department of Obstetrics, Gynecology & Reproductive Health Sciences, University of Texas
Houston, Texas, United States
DG
Danna Ghafir, BA
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
TG
Tala Ghorayeb, MD
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
SS
Sandra Sadek, MD
University of Texas Science Center Houston
Houston, Texas, United States
ND
Nahla Daye, MD
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston
Houston, Texas, United States
Suneet P. Chauhan, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Baha M. Sibai, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Michal Fishel Bartal, MD, MS (she/her/hers)
Maternal Fetal Medicine Faculty
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States