Glycemic Control Trajectories and Associated Risk Factors among Women with Gestational Diabetes (GDM)

Although glycemic control (GC) is the cornerstone of GDM management, data on GC trajectories are lacking. We aimed to identify GC trajectories from GDM diagnosis to delivery and examine their associations with patient and social factors. In a multi-racial/ethnic cohort of 28,026 GDM patients in Kaiser Permanente Northern California, self-monitored blood glucose (SMBG) levels were recorded by a centralized monitoring program. Optimal GC was defined as ≥80% of SMBG meeting the ADA goals (fasting ≤95 mg/dL; 1-hr postprandial ≤140 mg/dL). Latent class models profiled GC trajectories using serial SMBG measurements. On average, women with GDM had 19.9 (SD 13.4) counts of SMBG values/week over 11.8 (6.6) weeks. Four GC trajectories were identified: stably optimal (G1: 47.3%), low to optimal (G2: 26.4%), moderate with fluctuations (G3: 9.3%), and low to moderate (G4: 17.1%). 90% of patients improved GC across pregnancy; 75% reached optimal GC by 10 weeks after GDM diagnosis. Compared to G1, non-white race, obesity, alcohol use, and GDM severity were positively, whereas adherence to the monitoring program and SMBG daily frequency were inversely associated with G2-4 (P <0.05). Compared to G2, neighborhood poverty, Medicare/Medicaid, multiparity, smoking, GDM severity, and GDM diagnosis at <24 weeks’ gestation were positively associated with G4 (P <0.05). Our findings may inform interventions to optimize GC.View largeDownload slideView largeDownload slide DisclosureY. Zhu: None. M. Greenberg: None. A. Ngo: None. J. Feng: None. A. Ferrara: None.FundingNational Institute of Diabetes and Digestive and Kidney Diseases (P30DK092924)