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A new study supports the value of continuous glucose monitoring (CGM) in pregnant women with diabetes

In analyzing CGM data from two clinical trials, researchers identified distinct temporal patterns of glucose excursions associated with large-for-gestational age (LGA) babies.

Functional data analysis of CGM data "allows us to understand where, when and how we might better invest efforts to optimize glucose control (and thus improve pregnancy outcomes)," Dr. Eleanor M Scott, from Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK, told Reuters Health by email.

"We identified specific times of day that maternal glucose excursions were associated with LGA infants. This was visible when conventional ways of assessing glucose did not show any differences," she explained. "This is new information and allows treatment to be targeted specifically to avoid these patterns. Essentially this analysis of CGM is like suddenly being able to view glucose through a microscope rather than with the naked eye."

Up to half of babies born to women with diabetes are LGA, which can lead to problems during childbirth and with later-life problems, such as diabetes, obesity and cardiovascular disease.

Dr. Scott and colleagues analyzed 1.68 million glucose measurements from 759 measurement episodes, obtained in a total of 117 women with type 1 or type 2 diabetes who had used repeated CGM during pregnancy as part of two earlier trials.

Fifty-four of the women (46%) delivered an LGA infant, according to the report, online April 23 in Diabetes Care.

LGA was associated with lower mean glucose (7.0 vs. 7.1 mmol/L; p<0.01) in the first trimester and with higher mean glucose in the second (7.0 vs. 6.7; p<0.001) and third trimester (6.5 vs. 6.4; p<0.01).

The lower mean glucose levels associated with LGA in the first trimester were driven by distinct dips in glucose levels in the midmorning (9 am to 11 am) and midevening (7 pm to 9:30 pm) hours. The higher average glucose levels associated with LGA in the second and third trimester were driven by significantly higher glucose levels in the early morning (3:30 am to 6:30 am) and throughout the afternoon (11:30 am to 5 pm) in the second trimester, and during the late evening in the third trimester (8:30 pm to 11:30 pm).

"This work also adds support to using CGM in pregnancy," Dr. Scott told Reuters Health, adding that "at the moment its use is very limited."

In a statement, study co-author Dr. Anna Secher, of the Center for Pregnant Women With Diabetes at the University of Copenhagen said CGM has been used for many years at her center, "but this study is the first to investigate glucose levels 'round the clock' in relation to large babies."
Source: Diabetes Care 2015
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