Oral Plenary Session 1
Oral Plenary Sessions
Noelia Zork, MD
Associate Professor
Columbia University Irving Medical Center
New York, New York, United States
Alan Kuang, MS
Senior Biostatistician
Northwestern University
Chicago, Illinois, United States
Patrick M. Catalano, MD
Reproductive Endocrinology
MGH REU
Boston, Massachusetts, United States
Francesca Facco, MD
Associate Professor, Maternal-Fetal Medicine
UPMC
UPMC, Pennsylvania, United States
Maisa Feghali, MD
Associate Professor
Magee Women's Research Institute, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
William A. Grobman, MBA, MD
Professor
Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
Erin S. LeBlanc, MD, MPH
Kaiser Permanente Center for Health Research
Portland, Oregon, United States
William L. Lowe, MD
Northwestern University
Northwestern University, Illinois, United States
Audrey Merriam, MD, MS
Yale School of Medicine
Yale School of Medicine, Connecticut, United States
Mirella Mourad, MD
Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States
Caryn E.S. Oshiro, MS, PhD
Investigator
Kaiser Permanente Hawaii, Center for Integrated Health Care Research
Honolulu, Hawaii, United States
Camille E. Powe, MD (she/her/hers)
Associate Professor
Massachusetts General Hospital
Boston, Massachusetts, United States
Uma M. Reddy, MD, MPH
Professor
Columbia University Irving Medical Center
New York, New York, United States
Dwight J. Rouse, MD, MSPH
Professor
Women & Infants Hospital of Rhode Island / Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
Jennifer Sherr, MD, PhD
Yale School of Medicine
New Haven, Connecticut, United States
Alexandra C. Spadola, MD
Clinical Associate Professor, Maternal Fetal Medicine
Tufts University School of Medicine
Boston, Massachusetts, United States
Kimberly K. Vesco, BA, MD, MPH
Distinguished Investigator
Kaiser Permanente Center for Health Research
Portland, Oregon, United States
Lynn M. Yee, MD, MPH (she/her/hers)
Associate Professor
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Denise Scholtens, PhD
Professor and Division Chief
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Erika F. Werner, MD, MS (she/her/hers)
President, Physician Organization; Professor, Maternal-Fetal Medicine
Tufts University School of Medicine
Boston, Massachusetts, United States
To evaluate whether maternal glycemia in early pregnancy is independently associated with adverse neonatal outcomes in individuals without overt diabetes.
Study Design:
At 9 U.S. sites we conducted a planned secondary analysis of a prospective cohort study of participants aged ≥ 18years with singleton gestations who underwent masked 75‑g OGTT, HbA1c, and 10‑days of continuous glucose monitoring (CGM) at 10–14 wks. Births at ≥ 20wks without major anomalies were analyzed. The primary outcome was a composite which included neonatal hypoglycemia, respiratory morbidity, birth injury, hyperbilirubinemia, stillbirth, and neonatal death. Exposures variables were OGTT values continuous and binary (any fasting values > 101mg/dL, 1-h > 135mg/dL, or 2-h > 132mg/dL), HbA1c (continuous and binary: ≥ 5.6%), and nocturnal (12am-6am) hyperglycemia on CGM (continuous: % time > 133mg/dL; binary: ≥ 9% time above > 133mg/dL). OGTT, HbA1c, and CGM thresholds were selected to optimize prediction of gestational diabetes in the primary analysis. Generalized linear regression models were sequentially adjusted for pre-defined sets of potential confounders: Model 1 included participant demographics, Model 2 added socioeconomic factors, and Model 3 added BMI.
Results:
Among 2037 participants, 239 (11.7%) newborns experienced the composite outcome (Table 1). Fasting glucose (mean 86.8mg/dL, +/- 7.2) was associated with the composite outcome in all three models, though effect sizes were slightly attenuated after adjustment for BMI (RR 1.2, fasting glucose higher by 1SD [95% CI 1.02, 1.30]). The binary OGTT and continuous 1-h, and 2-h glucose values were associated with the composite outcome in Models 1 and 2, but not Model 3. HbA1c showed no association with outcomes. Nocturnal hyperglycemia using a binary CGM threshold was associated with outcomes in all three models (RR 1.4 [1.0, 1.9]), whereas continuous CGM was not (Table 2).
Conclusion:
In this cohort without overt diabetes, fasting glucose and nocturnal hyperglycemia on CGM in early pregnancy were associated with a higher risk for adverse neonatal outcomes.