66-OR: Using Continuous Glucose Monitoring to Identify Neonatal Hypoglycemia following Gestational Diabetes—The DiGest Newborn Study

Introduction: Offspring exposed to intrauterine hyperglycemia are at risk of neonatal hypoglycemia (NH) and associated neurocognitive dysfunction in later life. As prevalence of gestational diabetes increases, early identification and treatment of NH is crucial to avoid long-term sequelae. We assessed the efficacy of current perinatal guidelines to identify NH using continuous glucose monitoring (CGM) in neonates.

Methods: Pregnant women with gestational diabetes from the DiGest trial (ISRCTN; 37866) were recruited to wear a masked Dexcom G6 CGM device intrapartum. Masked CGM was also sited on the infant thigh within 4 hours of life. NH was defined as glucose <47 mg/dL (2.6 mmol/L), with a target glucose range of 47-180 mg/dL (2.6-10.0 mmol/L).

Results: 13 mother-infant dyads with paired data were included in this analysis. Maternal characteristics were: white (62%), mean (SD) age 32.3 (5.8) years, mean (SD) booking BMI 32.1 (4.8) kg/m² and Caesarean section delivery (69%) at mean (SD) 38.9 (0.6) weeks gestation. Neonates (69% male, Apgars >9) wore CGM for mean (SD) 3.9 (1.9) days with mean percent time below range (TBR) 2.8 (5.6)%, and a mean (SD) glucose 91.8 (19.8) mg/dL (5.1 (1.1) mmol/L). CGM identified periods of suspected NH which were not detected clinically with standard monitoring and were identified after the first 24 hours of life, outside of typical monitoring periods. CGM was well tolerated by mothers and neonates.

Conclusions: CGM may offer novel opportunities to improve the identification of NH following gestational diabetes.