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Labor

Poster Session 2

(561) Characterization of glucose values in labor by continuous glucose monitoring in gravidas without diabetes mellitus

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Current recommendations for glycemic control during labor in those with diabetes mellitus (DM) are based upon expert opinion. Our objective was to characterize glucose values in labor using continuous glucose monitors (CGM) in term, laboring gravidas without DM to define normoglycemia.

Study Design:

Prospective observational cohort. CGM was placed in early labor. The following metrics were obtained: glucose at delivery, mean glucose over the 2 hours(hrs) prior to delivery, mean glucose in active and 2nd stage of labor, time in range (TIR) defined as 70-120 mg/dl, time above range (TAR) defined as >120mg/dL, and time below range (TBR) as < 70mg/dL. Neonatal outcomes were assessed. Python 3.10.4 was used for analysis of CGM data and SPSS was used for univariate analysis.

Results:

Seventy-two participants were included. Fifty-one (71%) delivered vaginally and 21 (29%) via cesarean. The mean glucose value at delivery was 109+27 mg/dL and over the 2hrs prior to delivery was 99+23 mg/dL.  26% of patients had a glucose >120mg/dL at time of delivery. Mean glucose in active labor was 101+25 mg/dL and in the 2nd stage was 99.5+ 23mg/dL. Average TIR from CGM placement to delivery was 69.8% (10-90th percentile 33.8-95.8%) and in the 2hrs prior to delivery was 68.7% (10-90th percentile 0.8-100%). Average TAR for time in labor was 19.9% (10-90th percentile 0-66.2%) and 2hrs prior to delivery was 22.8% (10-90th percentile 0-99%). Average TBR for time in labor was 10.3% (10-90th percentile 0-66%) and 2hrs prior to delivery was 8.5%(10-90th percentile 0-36%).  23 infants had glucose checked for clinical indications and 6 (26%) required treatment for neonatal hypoglycemia.

Conclusion:

Hyperglycemia was common in patients without DM, with a TAR in labor of nearly 20% and more than 25% of gravidas exceeding glucose of 120mg/dL at delivery. To our knowledge, this is the first study characterizing glucose patterns in women without DM in labor. This data challenges contemporary definitions of normoglycemia in labor. Further study is needed to better define normoglycemia in labor and identify risk factors for adverse outcomes.