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Diabetes

Poster Session 3

(657) Timing of insulin initiation in Gestational Diabetes and fetal growth curves

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: There is a large variation in clinical practices regarding the optimal insulin management of gestational diabetes (GDM). Data suggests earlier and tighter pharmacotherapy improves maternal and neonatal outcomes but can have different implications on fetal growth. We sought to explore the association between lower threshold for insulin initiation in GDM and fetal growth curves throughout pregnancy.

Study Design: Retrospective cohort study comparing 2 groups of patients with GDM requiring insulin 2011-2019 in a single academic center. Group 1 was started on insulin when ≥ 40% of capillary blood glucose (CBG) values were above goal, and Group 2 when 20-39% of CBG values were above goal. Patients who received less than two ultrasounds (US) in the third trimester, GDMA1, and those who received oral antidiabetic medications were excluded.  The primary outcome was estimated fetal weight using the Hadlock formula. Secondary outcomes were individual biometry indices (head circumference, biparietal diameter, abdominal circumference, and femur length) obtained during serial growth ultrasounds. Generalized linear models were used to model and compare the change in estimated fetal weight and in individual biometry indices as a function of gestational age between the two groups of GDM patients.

Results: A total of 401 participants met all inclusion criteria. There were no significant differences in baseline maternal characteristics, gestational age at insulin initiation, or number of US performed throughout pregnancy between the groups. Estimated fetal weight and biometry indices were similar between the groups (Figure). The abdominal circumference curve demonstrated slower growth in the late third trimester in Group 2, the earlier insulin initiation group, but the difference did not reach statistical significance.

Conclusion: Tighter insulin therapy does not affect fetal growth curves throughout pregnancy. The effect of earlier insulin initiation on reducing the growth of the abdominal circumference should be examined in larger cohorts.