Measuring glucose exposure and variability using continuous glucose monitoring in normal and abnormal glucose metabolism in pregnancy

Abstract

In pregnancy complicated by diabetes periods of hyperglycemia lead to accelerated fetal growth, resulting in a large for gestational age (LGA), or macrosomic, infant. Consequently, our aim was to measure the average volatility or variability in glucose control in women with and without diabetes in pregnancy. Methods: Continuous glucose monitoring (CGM) was employed in 82 pregnant study subjects to collect and record unbiased self-monitored glucose values. We obtained results from 51 women with normal glucose tolerance in pregnancy (NGTP), 25 gestational diabetes (GDM) and 6 women with pregestational diabetes (PreGD) between 18 and 45 (32 ± 6) years of age. Results: Significant differences (p < 0.001) were found in glucose exposure between NGT and all but PreGD; whereas the percent of time in hypoglycemia was significantly (p < 0.0001) higher in all pregnancy groups when compared to the nonpregnant sample. We conclude that CGM confirmed that diurnal glucose patterns differ throughout the day by 20% when pregnant and nonpregnant states are compared. Indeed, maintenance of a narrow range in pregnancy is characteristic in women without diabetes, and CGM throughout pregnancy is critical, if mimicking normal glucose patterns is to be achieved.

Keywords::

• CGM
• gestational glycemia
• glycemic profile
• perinatal outcomes
• stability

Acknowledgements

The authors wish to acknowledge the contributions of Michael Bancks for his assistance in the preparation of this manuscript. Mr. Bancks worked on the narrative as well as assisted in the statistical analysis. This work was originally presented at the 12th Annual Meeting of the Diabetes in Pregnancy Study Group of North America, 1–2 April 2011, Washington, DC, USA.

Declaration of Interest: The authors have no declarations of interest to report.