Longitudinal changes in the continuous glucose profile measured by the CGMS in healthy pregnant women and determination of cut-off values.
OBJECTIVE
This longitudinal study performed continuous evaluation of daily blood glucose level profiles in healthy normal-weight pregnant patients during various gestational age and determined normal levels.


METHODS
Thirty-two healthy normal-weight pregnant women received a continuous glucose monitoring system (CGMS) device for periods of 72h in the 16th, 22nd, 30th and 36th weeks of gestational age and at 6 weeks after delivery. All observations took place in the outpatient clinic of the Charité hospital. The daily blood glucose level profiles obtained with the CGMS provided pre- and postprandial blood glucose levels and a mean glucose value for a 24-h period. Caloric intake was determined using detailed food logs. Additionally, a fetal biometry and an measurement of maternal weight were performed at each visit. The correlation was tested using Spearman's test.


RESULTS
The average age of the study subjects was 29.6+/-4.5. Average pre-pregnancy BMI was 22.4+/-2.5kg/m(2). The births occurred on average in the 40th week of pregnancy. Average caloric intake was 2223+/-356kcal. No significant changes in caloric intake were observed during the course of the study. The blood glucose levels showed a significant rise throughout the course of the pregnancy, going from 4.84+/-0.4mmol/l (87.2+/-7.2mg/dl) during the 30th week of pregnancy to 5.22+/-0.5mmol/l (94.0+/-9.0mg/dl) during the 36th week (p=0.002). Postpartum levels were 5.20+/-0.5mmol/l (93.7+/-9.0mg/dl) (p=0.51). Fasting blood glucose levels did not change during the course of the pregnancy. A noticeable aspect were the significantly increased fasting postpartum levels with 5.02+/-0.6mmol/l (90.4+/-10.8mg/dl) (p=0.00). Analysis of the postprandial glucose levels confirmed a rise from 5.30+/-0.6mmol/l (95.5+/-10.8mg/dl) in the 16th week to 6.14+/-0.7mmol/l (110.6+/-12.6mg/dl) in the fourth study phase (36th week), and a decrease after the birth to 5.59+/-0.6mmol/l (100.7+/-10.8mg/dl). These measurements were adapted to the gestational age.


CONCLUSIONS
Continuous measured glucose levels rose during the pregnancy in healthy pregnant women in spite of normal pre-pregnancy metabolism and unchanged carbohydrate intake during gestation. These results suggest the necessity of gestational-age-dependent cut-off values.
Siegmund
Tina
T
Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.
Rad
Neda Talai
NT
Ritterath
Claudia
C
Siebert
Gerda
G
Henrich
Wolfgang
W
Buhling
Kai J
KJ
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D005215:Fasting; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D018670:Monitoring, Ambulatory; D019518:Postprandial Period; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000097:blood*; D011263:Pregnancy Trimester, Third / Q000097:blood*; D011446:Prospective Studies; D012016:Reference Values
D001786:Blood Glucose