Correlation of Continuous Glucose Monitoring Profiles with Pregnancy Outcomes in Nondiabetic Women

Abstract

Objective To determine whether hyperglycemic excursions detected by continuous glucose monitoring (CGM) correlate with birth weight percentile and other pregnancy outcomes, and whether CGM correlates better with these outcomes than a single glucose value from a 1-hour glucose challenge test (GCT).

Study Design This was a prospective observational study of 55 pregnant patients without preexisting diabetes, who wore a CGM device for up to 7 days, between 24 and 28 weeks' gestation. The area under the curve (AUC) of hyperglycemic excursions above various thresholds (110, 120, 130, 140, and 180 mg/dL) was calculated. These AUC values, and results from a standard 50-g GCT, were correlated with our primary outcome of birth weight percentile, and secondary outcomes of unplanned operative delivery, pregnancy complications, delivery complications, fetal complications, and neonatal complications.

Results A consistent correlation was seen between all AUC thresholds and birth weight percentile (r = 0.29, p < 0.05 for AUC-110, −120, −130, and −140; r = 0.25, p = 0.07 for AUC-180). This correlation was stronger than that of 1-hour oral GCT (r = −0.02, p = 0.88). There was no association between AUC values and other outcomes.

Conclusions Among nondiabetic pregnant patients, hyperglycemic excursions detected by CGM show a stronger correlation to birth weight percentile than blood glucose values obtained 1-hour after a 50-g oral GCT.

Keywords

birth weight - continuous glucose monitoring - pregnancy

• References

• 1 Engelgau MM, Herman WH, Smith PJ, German RR, Aubert RE. The epidemiology of diabetes and pregnancy in the U.S., 1988. Diabetes Care 1995; 18 (7) 1029-1033
• 2 Hunt KJ, Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am 2007; 34 (2) 173-199 , vii
• 3 Nold JL, Georgieff MK. Infants of diabetic mothers. Pediatr Clin North Am 2004; 51 (3) 619-637 , viii
• 4 O'Sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes 1964; 13: 278-285
• 5 Metzger BE, Lowe LP, Dyer AR , et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358 (19) 1991-2002
• 6 Committee on Practice Bulletins--Obstetrics. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2, Pt 1) 406-416
• 7 Metzger BE, Gabbe SG, Persson B , et al; International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33 (3) 676-682
• 8 Sung JF, Taslimi MM, Faig JC. Continuous glucose monitoring in pregnancy: new frontiers in clinical applications and research. J Diabetes Sci Tech 2012; 6 (6) 1478-1485
• 9 Bailey T, Zisser H, Chang A. New features and performance of a next-generation SEVEN-day continuous glucose monitoring system with short lag time. Diabetes Technol Ther 2009; 11 (12) 749-755
• 10 Zisser HC, Bailey TS, Schwartz S, Ratner RE, Wise J. Accuracy of the SEVEN continuous glucose monitoring system: comparison with frequently sampled venous glucose measurements. J Diabetes Sci Tech 2009; 3 (5) 1146-1154
• 11 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (2) 377-381
• 12 Taslimi MM, Navabi K, Acosta R, Helmer A, El-Sayed YY. Concealed maternal blood glucose excursions correlate with birth weight centile. J Diabetes Sci Tech 2008; 2 (3) 456-460
• 13 Oken E, Kleinman KP, Rich-Edwards J, Gillman MW. A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr 2003; 3: 6
• 14 Dalfrà MG, Sartore G, Di Cianni G , et al. Glucose variability in diabetic pregnancy. Diabetes Technol Ther 2011; 13 (8) 853-859
• 15 Dmitrovic R, Katcher HI, Kunselman AR, Legro RS. Continuous glucose monitoring during pregnancy in women with polycystic ovary syndrome. Obstet Gynecol 2011; 118 (4) 878-885
• 16 Sung JF, Taslimi MM, El-Sayed YY. Continuous glucose monitoring during pregnancy in women with polycystic ovary syndrome. Obstet Gynecol 2012; 119 (2, Pt 1) 383-384 , author reply 384