488: Efficacy of continuous glucose monitoring in diabetic pregnancy, the glucomoms trial

Hyperglycemia in pregnancy is associated with poor neonatal outcome. Glycemic control is traditionally monitored with self-measured glucose profiles and periodical HbA1c measurements. We investigated the efficacy of Continuous Glucose Monitoring (CGM), a novel tool to monitor blood glucose levels, in diabetic pregnancies on the incidence of large for gestational age (LGA) infants. In a multicenter open label randomized controlled trial, pregnant women >18 years with diabetes type 1, or type 2 on insulin therapy (gestational age (GA)<16 weeks) or insulin dependent gestational diabetes (GA<30 weeks) were randomly allocated to intermittent use of retrospective CGM for 5-7 days every 6 weeks. All women determined their glycemic control by self-monitoring of blood glucose levels and HbA1c measurements. LGA (birth weight >90th centile) was the primary outcome and secondary outcomes were glycemic control, maternal and neonatal complications. Primary analyses were performed according to intention to treat, while a secondary per-protocol analysis was limited to women using the CGM at least once every trimester after randomization. Between July 2011 and September 2015, we randomized 304 women (109 type 1, 83 type 2, 112 gestational diabetes), 150 to CGM and 154 to conventional treatment. Twelve patients could not be included in the analyses due to withdrawal of consent (6), miscarriage (4), or lost to follow up (2). The incidence of macrosomia was 29% in both the intervention and control group (RR .99, 95%CI .76-1.28). No difference was observed in the per protocol analysis (66% of total population, RR 1.00, 95%CI .70-1.42). No difference was seen in glycemic control in terms of HbA1c throughout pregnancy (figure). Preeclampsia was less common in the CGM group, while no other differences were seen on maternal and neonatal outcomes (table). Intermittent CGM use in diabetic pregnancy does not reduce the incidence of LGA infants.View Large Image Figure ViewerDownload Hi-res image Download (PPT)