Use of diabetes technology, blood glucose targets and birth outcomes of patients with type 1 diabetes in pregnancy at Christchurch women’s hospital in 2022. — ASN Events
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Use of diabetes technology, blood glucose targets and birth outcomes of patients with type 1 diabetes in pregnancy at Christchurch women’s hospital in 2022. (#61)

Joanna Paggi 1 2 , Catherine Conway 1 3 , Nilu Hewapathirana 1 3 , Liz Love 2 3 , Tory Crowder 2
  1. Christchurch Women's Hospital, Te Whatu Ora, Christchurch, Waitaha/Canterbury, New Zealand
  2. Nutrition and Dietetics, Christchurch Hospital, Te Whatu Ora, Christchurch, Waitaha/Canterbury, New Zealand
  3. Diabetes Centre, Te Whatu Ora, Christchurch, Waitaha/Canterbury, New Zealand

Background: During pregnancy, women with type 1 diabetes (T1D) require tighter glycaemic targets to reduce risk of adverse pregnancy outcomes1. Continuous glucose monitoring (CGM) improves time spent in the glucose target range of 3.5-7.8mmol/L (TIR) and consequently neonatal outcomes2,3.

Aim: To audit the use of diabetes technology, number of women achieving TIR and birth outcomes of women with T1D referred to the diabetes in pregnancy (DIP) clinic at Christchurch Women’s Hospital.

Method: All women with T1D referred to the DIP clinic between January to December 2022 were included. Data on TIR was collected from the CGM reports or electronic patient records. The time points analysed for TIR were closest point to 12 weeks gestation, closest point to, but not after 28 weeks gestation and closest point to 33 weeks gestation. The TIR target was defined as >70%. Birth weight and admission to the neonatal intensive care unit (NICU) for >24 hours were collected from electronic patient records. For birth weight, small for gestation age (SGA) was defined as <10th percentile on population and sex-specific growth charts, normal weight as 10th-89th percentile and large for gestational age (LGA) as ≥90th percentile.

Results: 22 women with T1D were referred to the DIP clinic. A CGM device was used by 21 (95%) women during pregnancy. CGM data was available for 91% of the time points assessed. Women met the TIR target 22% at 12 weeks gestation, 25% at 28 weeks gestation and 33% at 33 weeks gestation. An insulin pump was used by eight (36%) women. All insulin pumps had been commenced prior to pregnancy. Women on insulin pumps met the TIR target 37% at 12 weeks gestation, 37% at 28 weeks gestation and 50% at 33 weeks gestation. Birth outcomes are available for 19 infants; two are yet to birth and one woman miscarried in the first trimester. No infants were born SGA, 12 (63%) were normal weight and seven (37%) were LGA. Five (26%) infants were admitted to the NICU.

Conclusion: CGM use in our clinic was high. Despite this, the number of women achieving pregnancy TIR was low. TIR improved if an insulin pump was used. Strategies to improve TIR in our clinic are required as we would expect this to result in improved birth outcomes.

  1. Rudland VL, Price SAL, Hughes R, et al. ADIPS 2020 guideline for pre-existing diabetes and pregnancy. Aust N Z J Obstet Gynaecol. 2020;60(6):E18-E52. doi:10.1111/ajo.13265
  2. Feig DS, Donovan LE, Corcoy R, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial [published correction appears in Lancet. 2017 Nov 25;390(10110):2346]. Lancet. 2017;390(10110):2347-2359. doi:10.1016/S0140-6736(17)32400-5
  3. Murphy HR, Rayman G, Lewis K, et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomized clinical trial. BMJ. 2008;337: a1680. doi:10.1136/bmj.a1680
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