Continuous Glucose Monitoring-Derived Differences in Pregnancies With and Without Adverse Perinatal Outcomes

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Perinatal Medicine

Background:

• Adverse perinatal outcomes, including fetal growth disorders and hypertensive disorders of pregnancy (HDP), pose significant risks.
• Understanding glycemic patterns during pregnancy is crucial for predicting and potentially preventing these complications.

Purpose of the Study:

• To investigate the association between continuous glucose monitoring (CGM)-derived glycemic patterns in early pregnancy and adverse perinatal outcomes.
• Specifically, to determine if glycemic patterns predict fetal growth disorders (large-for-gestational-age [LGA] and small-for-gestational-age [SGA] neonates) and HDP.

Main Methods:

• A prospective observational study included 760 participants with singleton pregnancies and no pre-existing diabetes.
• Participants underwent blinded continuous glucose monitoring (CGM) for at least 14 days.
• Glycemic metrics derived from CGM were analyzed and compared between participants with and without adverse perinatal outcomes using two-sample t tests.

Main Results:

• Participants delivering LGA neonates or diagnosed with HDP exhibited higher mean glucose levels and spent more time with glucose levels above 120 mg/dL and 140 mg/dL throughout gestation.
• These associations persisted regardless of gestational diabetes mellitus status.
• Participants with SGA neonates had lower mean glucose levels, less time above 140 mg/dL, and more time below 63 mg/dL compared to controls.

Conclusions:

• Elevated mean glucose levels and increased time spent hyperglycemic in early pregnancy are associated with LGA neonates and HDP.
• Conversely, lower mean glucose levels and increased time spent hypoglycemic are linked to SGA neonates.
• CGM-derived glycemic patterns offer valuable insights into perinatal risk prediction during pregnancy.