Postpartum glycemic trends among people with gestational diabetes using continuous glucose monitoring

During the immediate postpartum period, glycemic changes among persons with gestational diabetes (GDM) have not been well characterized.

Using continuous glucose monitoring (CGM) data, we sought to explore the differences in postpartum glycemic trends among people with GDM by patient-level characteristics.

This study was an exploratory secondary analysis of pregnant people with GDM randomized to using CGM versus capillary blood glucose during pregnancy. Participants without CGM data in the immediate postpartum period were excluded from analysis. Our primary outcome was mean glucose by hour from delivery through the first 48 hours postpartum. We performed additional analyses stratified by GDM type, mode of delivery and time in range during pregnancy (≥90% TIR, 63-140mg/dL) to determine differences in postpartum glycemia among these cohorts.

Of the 111 participants in the overall trial, we included 79 participants with postpartum data in this secondary analysis, of which 22.8% had A1GDM and 77.2% had A2GDM. Overall, there was a slight downward trend in glucose values over the first 48 hours post-delivery. Participants with A1GDM had lower mean glucose by 48 hours compared to those with A2GDM, as did participants with high percent TIR (≥90%) compared with lower percent TIR during pregnancy. Participants with higher gestational mean glucose and percent time-above-range (TAR) had higher mean glucose during the 48 hours post-delivery compared to those with lower gestational mean glucose and time-above-range.

We found that postpartum mean glucose trended downward after delivery and varied by multiple pregnancy and delivery characteristics. Future studies should assess whether differences in postpartum glycemic parameters are associated with clinically relevant outcomes.