Mrs Jessica Burk1, Associate Professor Glynis Ross2, Professor Teri Hernandez3,4,5, Professor Stephen Colagiuri1, Dr Arianne Sweeting1,2
1Faculty of Medicine and Health, University of Sydney, Camperdown, Australia, 2Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, Australia, 3College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, USA, 4Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, USA, 5Children's Hospital Colorado, Aurora, USA
Biography:
Jessica Burk is a research dietitian and PhD candidate. She worked as a research dietitian in the Boden Clinical Trials Unit within the Charles Perkins Centre at the University of Sydney for nine years and in 2023 commence her full-time PhD candidature in carbohydrate modification in gestational diabetes.
Abstract:
Background and Aims: Diabetes in Pregnancy (DIP: type 1 [T1D], type 2 [T2D] and gestational diabetes [GDM]), is associated with perinatal complications driven by maternal hyperglycaemia.¹ ² Continuous glucose monitoring (CGM) is now recommended in individuals with T1D during pregnancy,³ but its benefits across DIP are unclear. We evaluated the relationship between maternal glucose, CGM metrics and perinatal outcomes in DIP.
Method: Systematic search of Medline, Embase, CENTRAL, CINAHL and Scopus from 2003-2023. Randomised controlled trials and prospective cohort trials examining the relationship between CGM, glucose metrics (pregnancy ranges) and perinatal outcomes in DIP were included. Pooled results from individual studies to estimate summaries of mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI) were undertaken for HbA1c (%) and perinatal outcomes with GRADE assessment.
Results: Of 4,016 studies, 235 underwent full text review, and 20 studies met criteria for inclusion and data extraction. The number of participants ranged from 40-340 and CGM duration from 48-h to throughout pregnancy. In T1D, CGM improved HbA1c (n=3 studies) (MD:-0.23[95%CI -0.37,-0.09]), time-in-range (TIR), mean glucose and glycaemic variability (GV), and reduced risk of large-for-gestational-age (LGA) (n=3) (OR:0.70[95%CI 0.51,0.95]) and neonatal intensive care admission (n=2) (OR:0.51[95%CI 0.32,0.84]) (GRADE: moderate). Increased first trimester time-below-range (TBR) in T1D was associated with reduced preterm birth. In GDM, CGM reduced HbA1c (n=5) (MD:-0.18[95%CI -0.33,-0.02)], LGA (n=7) (OR:0.62[95%CI 0.42,0.93]), and neonatal hypoglycaemia (n=7) (OR:0.60[95%CI 0.38,0.96]) (GRADE: low-moderate). A single study reported lower third trimester GV reduced preeclampsia, macrosomia and neonatal hypoglycaemia. No studies in individuals with T2D in pregnancy correlated maternal CGM metrics with perinatal outcomes.
Conclusions: Increased pregnancy TIR and TBR (T1D) and reduced GV (T1D/GDM) may be associated with improved perinatal outcomes. Studies evaluating CGM use for longer duration in pregnancy would best demonstrate the association between CGM metrics and perinatal outcomes in DIP.
Keywords
'Continuous glucose monitoring", "Diabetes in pregnancy"
References
1. Sweeting A, Wong J, Murphy HR, Ross GP. A Clinical Update on Gestational Diabetes Mellitus. Endocrine reviews. 2022;43(5):763-93.
2. Murphy HR, Howgate C, O'Keefe J, Myers J, Morgan M, Coleman MA, et al. Characteristics and outcomes of pregnant women with type 1 or type 2 diabetes: a 5-year national population-based cohort study. Lancet Diabetes Endocrinol. 2021;9(3):153-64.
3. National Institute for Health and Care Excellence (NICE). Diabetes in Pregnancy. 2023.