Key Takeaways:
- New research highlights the benefits of dietary interventions and strict continuous glucose monitoring (CGM) metrics in late-stage gestational diabetes.
- The DiGest study found that reduced-calorie dietary interventions for women with gestational diabetes mellitus (GDM) in late-stage pregnancy reduced weight gain for mothers and resulted in more moderate birth weight for babies.
- Stricter CGM metrics were strongly associated with better pregnancy outcomes for mothers with GDM.
Gestational diabetes (GDM) occurs when unusually high blood sugar levels develop during pregnancy in individuals who did not previously have diabetes. GDM poses health risks for both the mother and child, including the possibility of giving birth to an unusually large baby, difficult deliveries, and increased health risks, such as type 2 diabetes, later in life for both the mother and child.
Standards for Gestational Diabetes Care: Current standards for managing GDM are still evolving. There are no universal guidelines for daily calorie or weight targets, and while there is a standardized time in range (TIR) for glucose levels during pregnancy, researchers are exploring whether stricter TIRs could further improve pregnancy outcomes.
Professor Claire Meek’s Research: Professor Claire Meek from the University of Leicester presented findings from her DiGest (Dietary Intervention in Gestational Diabetes) trial at the 2024 ADA conference. The DiGest trial investigated the effects of a reduced-calorie dietary intervention in late-stage pregnancy in women with GDM. Additionally, Meek conducted a secondary analysis suggesting that stricter glucose ranges benefit both mothers and babies, highlighting the importance of CGM metrics during pregnancy with diabetes.
DiGest Trial: Dietary Interventions
The five-year DiGest trial involved 425 women diagnosed with GDM and either overweight or obesity. Participants wore a blinded Dexcom G6 CGM at 29 and 36 weeks of pregnancy and were randomly assigned to receive either standard-calorie or reduced-calorie meals starting at 30 weeks of gestation. Both groups’ meals were balanced according to nutritional guidelines (40% carbohydrates, 25% protein, and 35% fat), and all participants received standard UK clinical GDM care, including regular ultrasounds and diabetes medication as needed.
Results:
- Weight Management: The 8-10 week diet intervention reduced weight gain for mothers.
- Birth Weight: Babies had more standardized birth weights.
- Health Benefits: Mothers who lost just 3% of their weight experienced a 7% increased TIR at 36 weeks, a drop of 3 points in systolic blood pressure, reduced size of babies without an increase in small for gestational age babies, and long-term improvements in maternal weight, body mass index, and A1C levels three months post-birth.
- Insulin Usage: Fewer participants on the reduced-energy diet needed long-acting insulin, and this group had lower post-birth A1C levels.
CGM Metrics and Pregnancy Outcomes
Meek used statistical modeling to analyze how CGM metrics from the DiGest trial correlated with various pregnancy outcomes, including preeclampsia, preterm delivery, higher-than-normal birth weight, NICU admission, and neonatal hypoglycemia.
Findings:
- A stricter TIR for pregnancy of 63-120 mg/dl was strongly associated with better outcomes compared to the standard range of 63-140 mg/dl.
- At 29 weeks, the stricter range correlated with lower rates of preeclampsia, large-for-gestational-age babies, NICU admission, and neonatal hypoglycemia.
- Zero cases of preeclampsia were observed in women who maintained more than 90% TIR within the stricter range.
- Positive pregnancy outcomes decreased at 36 weeks of pregnancy, and other positive health outcomes were linked with achieving the 90% or greater target for the traditional TIR.
Further Research
The DiGest Newborn Study followed 13 newborns from the original study to examine post-birth glucose trends and hypoglycemia patterns, suggesting that CGMs might be a feasible tool for identifying newborn hypoglycemia. Meek is now extending her research with the DiGest Follow-Up study, tracking 152 mothers and babies for three more years to prevent the development of type 2 diabetes in women who had GDM during pregnancy.
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