Oral Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2024

The association between glycaemia and pregnancy complications in early GDM (107385)

Jincy Immanuel 1 2 , N Wah Cheung 3 , Mahta Mohajeri1 1 , Daniel J Simmons 4 , William M Hague 5 , Helena Teede 6 , Christopher J Nolan 7 , Michael J Peek 8 , Jeff R Flack 9 , Mark Mclean 10 , Vincent Wong 11 , Emily J Hibbert 8 , Alexandra Kautzky-Willer 12 , Jürgen Harreiter 12 13 , Helena Backman 14 , Emily Gianatti 15 , Arianne Sweeting 16 , Mohan Viswanathan 17 , David Simmons 1
  1. School of Medicine, Western Sydney University, Sydney
  2. Texas Woman's university, Denton, Texas, United States
  3. Westmead Hospital, Sydney
  4. Techtonic software, Australia
  5. Robinson Research Institute, The University of Adelaide, SA, Australia
  6. Monash University, Melbourne, Vic, Australia
  7. Canberra Hospital and Australian National University, Canberra, Australia
  8. Faculty of Medicine and Health, University of Sydney and Nepean Hospital, Sydney, NSW, Australia
  9. Bankstown-Lidcombe Hospital, Sydney, Australia
  10. Blacktown Hospital, Sydney, Australia
  11. Liverpool Hospital, Sydney and University of New South Wales, NSW, Australia
  12. Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
  13. Department of Medicine, Landesklinikum Scheibbs, Austria
  14. Dept of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Sweden
  15. 15Department of Endocrinology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  16. Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  17. Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India

Background: The optimal timing for detecting and initiating treatment for gestational diabetes mellitus (GDM) remains a topic of debate and is largely understudied. Neonates born to women with GDM continue to experience metabolic and other complications despite receiving treatment from 24 weeks’ gestation (weeks’). This study investigates the association of timing of commencing glucose management with glycaemia, glycaemic variability, and pregnancy outcomes among women with GDM diagnosed before 20 weeks’ (early GDM - eGDM).

Methods:  This is a sub-study among participants of a trial of immediate vs delayed treatment of eGDM diagnosed by WHO-2013 criteria. All women treated immediately and those with delayed treatment following a reconfirmation of diagnosis at 24-28 weeks’ (i.e., treated as if late GDM) were instructed to monitor capillary blood glucose (BG) using an Accu-Chek Guide (Roche Products Ltd, Sydney, Australia) glucose meter 4 times/day (fasting and 2-h post-prandial), up-loading values to the Accu-Chek web-portal, until delivery. Optimal glycaemia was defined as ≥95% of BG measurements between 3.9-7.8 mmol/l. Meter data were later downloaded from the web-portal. Times of testing data were unavailable.

Results: Data from six sites (n=114) were not available for technical reasons. Overall, 107,716 BG values were obtained from 329/549 (59.9%) women with eGDM (mean age 32.3±4.9 years, Body Mass Index (BMI) 32.0±8.0 kg/m2 ethnicity 35% European, gestation at eGDM diagnosis 15.2±2.4 weeks’). Women treated early (n=213) showed lower mean glucose (MG) and mean fasting glucose (MFG) compared with those treated late (n=116) (MG: 5.7±0.4 vs. 5.9±0.5, p<0.001, MFG: 5.2±0.3 vs. 5.3±0.4, p=0.004) with greater optimal glycaemia (74.6% vs. 59.5%, p=0.006). Overall, optimal glycaemia was achieved in 69% of women: this was associated with lower birthweight (3.2±0.5 vs. 3.3±0.5kg, p=0.04), less large-for-gestational-age (LGA) babies (14.4% vs. 26.7%, p=0.01)  more small-for-gestational-age (SGA) babies (15.3% vs. 5.9%, p=0.02) and less gestational weight gain (GWG)(4.9±6.4 vs. 7.6±6.2, p=0.001). Prior GDM, 1-hour glucose at booking oral glucose tolerance test (OGTT), and greater GWG were associated with suboptimal glycaemia. Higher MFG (5.2-5.3 mmol/l) in the second trimester was associated with more respiratory distress, whereas, when present in the third trimester, MFG  ≥5.4 mmol/l was associated with more LGA babies and earlier gestation at birth. Booking BMI, fasting glucose at booking OGTT, and GWG were significant predictors of MFG  ≥5.4 mmol/l.

Conclusions: Early commencement of treatment in women with eGDM resulted in improved glycaemia which was associated with reduced fetal overgrowth.