Intrapartum glucose metrics associated with adverse neonatal outcomes among people with gestational diabetes mellitus.

Introduction: Hyperglycemia is a recognized risk factor for adverse neonatal outcomes. However, the impact of achieving glucose goals during labor on the risk of such outcomes remains poorly understood for individuals with gestational diabetes mellitus (GDM). We sought to compare continuous glucose monitoring (CGM) metrics between laboring GDM pregnancies complicated by adverse neonatal outcomes to those without complications. Methods: Secondary analysis of pregnant people with GDM randomized to using CGM versus capillary blood glucose (CBG) for management of GDM. Among all participants wearing a CGM during labor, we compared pregnancies that were complicated by a significant neonatal outcome as defined by a composite including one or more of the following: hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, or neonatal intensive care unit admission to those without this composite adverse outcome. Continuous variables were compared with two-sample Results: Of the 111 in the primary trial, 59 were included in this secondary analysis. A total of 52 of 111 patients in the primary trial were excluded, as 23 were missing intrapartum data and 29 had no trial of labor prior to cesarean delivery. The cohort with the composite adverse neonatal outcome spent significantly less intrapartum TIR between 70 and 120 mg/dL (62.7% vs. 80.7%, Conclusion: Intrapartum participants with GDM and a composite adverse neonatal outcome spent less TIR, more TAR, with a higher mean glucose in labor than those without a composite adverse outcome. A weak-to-moderate positive correlation between antenatal and intrapartum glucose management was observed.