(518) Intrapartum Fingerstick vs. Continuous Glucose Monitoring in Patients with Type 2 and A2 Gestational Diabetes

Maintaining intrapartum maternal euglycemia decreases adverse neonatal outcomes. Continuous glucose monitoring (CGM) is a new tool that may be employed in lieu of standard fingerstick point-of-care (POC) measurements during labor. We examined differences in neonatal outcomes in patients with type 2 diabetes mellitus (T2DM) or medication-controlled gestational diabetes (A2GDM) who used CGM versus POC glucose measurements for intrapartum monitoring.

Study Design:

We performed a retrospective chart review of patients with T2DM or A2GDM by ICD-10 who delivered between 9/2020-7/2024 at an urban academic hospital. Exclusion criteria were diet-controlled (A1) gestational diabetes, type 1 diabetes, multifetal gestation, antenatal steroid administration within 14 days of delivery, non-laboring (e.g. scheduled cesarean section), and nonviable pregnancies. We matched the POC group to CGM users by diabetes class, BMI, and age at delivery using randomized matching. Chi-square and t-tests were performed to evaluate maternal and fetal outcomes between groups.

Results:

Of 80 patients who met inclusion criteria, 35% (n=28) used CGM intrapartum while 65% (n=52) were monitored with standard POC measurements. Race, ethnicity, and type of diabetes mellitus did not differ across groups. Mean glucose was higher (109.7 vs. 100.2 mg/dL; U=970, p< 0.05) and time-in-range (70-110 mg/dL) lower (59.2; vs 72.1 percent; U=518.5, p< 0.05) in the CGM group. Though neonatal hypoglycemia was rare (3.8%, n=3), occurrences were not significantly different between groups (X2 (1) = 1.56, p=0.21). Similarly, need for insulin drip during labor (X2 (1) = 0.30, p=0.87) and maternal treatment of hypoglycemia (X2 (1) = 0.06, p=0.89) were not significantly different. Neonatal outcomes including gestational age, birthweight, birthweight percentile, initial glucose measurement, and hospital length of stay did not differ by group.

Conclusion:

Important clinical outcomes did not differ between CGM and POC glucose measurement groups during the intrapartum period for patients with A2GDM or T2DM.