961-P: Management of Gestational Diabetes (GDM): Are New Glycemic Targets Needed?

Background and Aim: There is no consensus on glycemic targets for the management of GDM. Since women with GDM managed with current glycemic targets show still worse pregnancy outcomes than women without it, we aim to identify which glycemic levels are associated to normal pregnancy outcomes with particular reference to Large for Gestational Age (LGA) rate.

Methods: This is an observational study, involving women with GDM (IADPSG criteria) from 2016 to 2019. Glycemic values <90 mg/dl at fasting and <130 mg /dl 1h after a meal were "in target." Blood Glucose (BG) levels and clinical factors were related to LGA/GDM adverse outcomes through Data Analysis, Multiple Correspondence Analysis and conceptual maps. The RECPAM (RECursive Partitioning and Amalgamation) analysis was used to identify homogeneous and distinct groups of patients at risk for LGA/adverse outcome and to set the glycemic value cut-off discriminating for LGA/adverse outcome.

Results: We analyzed 386 women and 40844 glycemic values. We found 4 natural categories for fasting BG (<78.2; ≥78.2 and <84; 84-89; ≥90 mg/dl) and 5 for post-prandial BG. Women exceeding the cut-off of 84 mg/dl at fasting > 2 times in the week, showed a high rate of LGA than those who did not (p 0.02), were more often overweight and needed insulin, enrolled earlier, had higher HbA1c values and an inadequate weight gain (p .001). The conceptual maps identified 3 clusters of women grouped homogeneously and distinctly according to BG and outcomes: women with fasting and postprandial BG included in the first two natural categories showed better outcomes than those with higher values, with a linear trend. BG> 84 mg/dL in more than 2/7 measurements, BMI> 25 kg/m2, and inadequate weight gain were predictive factors of LGA risk (OR 0.9 CI95% 1.2-5, p .012; OR 0.713 CI95% 1-3.8, p .029 OR 0.792 CI95% 1-4.8, p .04). Finally, RECPAM identified women with BMI> 25 kg/m2 and/or with fasting blood glucose> 97 mg/dl as a higher LGA risk subgroup.

Conclusions: Tighter glycemic targets for GDM management are needed.