Screening Earlier and Monitoring Post-Pregnancy
Detecting GDM Earlier to Avoid Complications
New findings presented at the ADA conference suggest that detecting and managing GDM much earlier in pregnancy can prevent complications and improve long-term outcomes. The current approach by the World Health Organization calls for GDM testing at 24-28 weeks of pregnancy. However, presenters argued for screening before 14 weeks to reduce severe pregnancy complications like preterm birth, low birthweight, stillbirth, and respiratory distress.
Changes in Body Function Due to GDM
Research indicates that the physiological changes due to GDM can occur not only in early pregnancy but also before pregnancy. Metabolic changes detectable before 14 weeks suggest the importance of preventing GDM pre-pregnancy.
Lifelong Health Outcomes
Early screening for GDM is also vital for reducing the risk of other health conditions post-pregnancy, such as obesity, high blood pressure, high cholesterol, liver disease, and cardiovascular disease. With metabolic conditions and type 2 diabetes rising worldwide, a comprehensive approach considering genetics, lifestyle, and environment is needed.
Dr. Helena Backman of Örebro University in Sweden emphasized the benefits of early GDM detection: “We can keep mothers and babies healthier during pregnancy and hopefully continue that path for a lifetime. What is needed now is earlier testing and an approach to managing GDM that considers available resources, circumstances, and personal wishes of the patient.”
CGM Use and Metrics
Push for CGM Use in All GDM Cases
While current ADA Standards of Care recommend CGM use for pregnant women with type 1 diabetes, this standard has not been set for GDM. Prof. Eleanor Scott of the University of Leeds highlighted inconsistent blood glucose meter testing in GDM patients, advocating for CGMs to be used universally in gestational diabetes pregnancies.
Stricter Time in Range Targets
A topic of discussion was adopting tighter time in pregnancy range (TIPR) targets. The current international consensus is 63-140 mg/dl. However, research presented by Dr. Celeste Durnwald and Prof. Claire Meek suggested that a narrower TIPR of 63-120 mg/dl could be associated with better pregnancy outcomes, including the absence of preeclampsia.
CGM-Derived Metrics in Newborns
The DiGest Newborn Study indicated that CGM might be an alternative for identifying neonatal hypoglycemia. Danielle Jones, a PhD candidate at the University of Cambridge, presented findings that suggest CGM and time in range metrics could be useful in identifying GDM babies with hypoglycemia. Dr. Kathleen Page of USC’s Keck School of Medicine also discussed how high blood sugars in the womb affect child brain development and metabolic health.
Automated Insulin Delivery (AID)
Growing Use of AID
Research supports the use of automated insulin delivery (AID) systems during pregnancy. Prof. Helen Murphy of the University of East Anglia presented results from the AiDAPT study, showing improved outcomes for type 1 diabetes pregnant mothers and their babies with the CamAPS FX AID system. In May 2024, the FDA cleared the use of CamAPS FX during pregnancy, making it the first AID system approved by the FDA for use in pregnancy.
Future Research Needs
While current research supports AID systems for type 1 diabetes during pregnancy, more studies are needed for gestational diabetes. Data presented at the ADA conference demonstrated significant improvements in time in range among people who were pregnant or trying to conceive, underscoring the potential benefits of AID systems.
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