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Diabetes

Poster Session 3

(787) Glycemic control in labor: Comparing time in range(TIR) among gravidas with and without pre-gestational diabetes

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Hyperglycemia in labor is associated with adverse neonatal outcomes in gravidas with diabetes (DM) including neonatal hypoglycemia. Our objective was to use continuous glucose monitors (CGM) to compare glucose control in gravidas in labor with and without DM. We hypothesized that gravidas without DM would have higher TIR compared to gravidas with DM.

Study Design: Prospective cohort study of term gravidas with CGM placed in early labor. TIR was defined as 70-120 mg/dl with time above range (TAR) >120 mg/dL and time below range (TBR) < 70mg/dL assessed at several labor stages. Gravidas with DM and their neonates were managed per standard institutional monitoring protocols with treatment of hyper- and hypoglycemia. Gravidas without DM and their neonates had glucose tested only if clinically indicated. CGM values were blinded. Chi-square, ANOVA and Python 3.10.4 were used for analysis.

Results: 90 gravidas were included: 72/90 (80%) without diabetes, 11/90 (12%) with type 1 diabetes (T1DM), and 7/90 (7.8%) with type 2 (T2DM). Mean TIR from CGM placement to delivery was 68.8%, 68.6% in active labor, and 70.5% in 2nd stage and did not differ between groups (Fig 1). The mean TAR from CGM placement to delivery was 22.4%, 21.2% in active labor, and 20.4% in 2nd stage and did not differ between groups. The glucose at delivery was highest in T1DM at 118+25 mg/dl and lowest in those without DM at 109+27 mg/dl (p=0.02). Overall, 11/90 (12%) of neonates were treated for hypoglycemia: 4/11 (36%) in the T1DM group, 2/7 (28.5%) in the T2DM group, and 5/72 (6.9%) in group without DM (p=0.008). Mean birthweight did not differ between groups. In multivariable analysis, higher birthweight, T1DM, and T2DM were associated with neonatal hypoglycemia with T1DM conferring the most risk (OR 13.2, 95% CI 2.0-89.6).

Conclusion:

Hyperglycemia in labor was common and did not differ in gravidas with and without diabetes. Neonatal hypoglycemia was more common in gravidas with T1DM, T2DM, and in heavier neonates. Further study is needed to define optimal glucose in labor among gravidas with diabetes.