Skip to main content
SMFM 2024 Pregnancy Meeting Main banner
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Poster Icons
Foundation Awardee
Foundation Awardee
No Social Media
No Social Media
Back
Q&A

Diabetes

Poster Session 1

(167) Do recommended continuous glucose monitoring thresholds apply to type 2 and gestational diabetes in pregnancy?

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Continuous glucose monitor (CGM) goals applied to pregnant people with type 1 diabetes include time-in-range (TIR) > 70%, time-above-range (TAR) < 25%, and glycemic variability (GV) ≤ 36%. Limited data support CGM use for gravidas with type 2 diabetes (T2DM) or gestational diabetes (GDM). We sought to determine risk of adverse perinatal outcomes (APOs) using various CGM thresholds in gravidas with T2DM/GDM.

Study Design:

In a retrospective analysis (2019-22) of gravidas at a single large center who used CGM for T2DM/GDM, we determined median 3rd trimester TAR, TIR, and GV in those with and without APOs using a target range 70-140 mg/dL. Generalized estimating equations determined odds ratios and 95% confidence intervals (CI) for hypertensive disorders of pregnancy (HDP), large-for-gestational age (LGA, birthweight ≥90%ile), neonatal intensive care unit (NICU) admission, neonatal hypoglycemia (NH, glucose ≤ 40 in first 24 hours), and jaundice (requiring phototherapy) at varying thresholds for each CGM metric in the 3rd trimester. Receiver operating characteristic analysis determined area under the curve (AUC) for varying thresholds for each metric.

Results:

Among 70 gravidas using CGM (T2DM: 48, GDM: 22), APOs occurred frequently (HDP, 43%; LGA, 13%; NICU admission, 29%; NH, 29%; and jaundice, 17%). For HDP, the TIR 90% (OR 3.3) and GV 20% (OR 5.3) thresholds were associated with the greatest odds of HDP. For LGA, TIR ≤ 75% (OR 7.2; AUC 0.73) and TAR ≥ 25% (OR 6.7; AUC 0.72) were associated with the greatest odds and discriminatory ability, while TIR 85% and TAR 15% had the greatest odds for NICU admission. Only TIR 75% was significantly associated with NH. Except for the aforementioned metrics for LGA, all other CGM metric thresholds had poor discriminatory ability for APOs (AUC < 0.7). GV thresholds were not associated with other APOs aside from HDP (GV > 20% vs. ≤ 20%: OR 5.3, CI 1.6-18.1).

Conclusion: In this cohort, recommended CGM thresholds for glycemic optimization during pregnancy had limited ability to distinguish risk of common APOs, beyond LGA, that complicate pregnancies with T2DM/GDM.