title: Analysis of Continuous Glucose Monitoring in Pregnant Women With Diabetes: Distinct Temporal Patterns of Glucose Associated With Large-for-Gestational-Age Infants.
abstract: OBJECTIVE
  Continuous glucose monitoring (CGM) is increasingly used to assess glucose control in diabetes. The objective was to examine how analysis of glucose data might improve our understanding of the role temporal glucose variation has on large-for-gestational-age (LGA) infants born to women with diabetes.
  
  
  METHODS
  Functional data analysis (FDA) was applied to 1.68 million glucose measurements from 759 measurement episodes, obtained from two previously published randomized controlled trials of CGM in pregnant women with diabetes. A total of 117 women with type 1 diabetes (n = 89) and type 2 diabetes (n = 28) who used repeated CGM during pregnancy were recruited from secondary care multidisciplinary obstetric clinics for diabetes in the U.K. and Denmark. LGA was defined as birth weight ≥90th percentile adjusted for sex and gestational age.
  
  
  RESULTS
  A total of 54 of 117 (46%) women developed LGA. LGA was associated with lower mean glucose (7.0 vs. 7.1 mmol/L; P < 0.01) in trimester 1, with higher mean glucose in trimester 2 (7.0 vs. 6.7 mmol/L; P < 0.001) and trimester 3 (6.5 vs. 6.4 mmol/L; P < 0.01). FDA showed that glucose was significantly lower midmorning (0900-1100 h) and early evening (1900-2130 h) in trimester 1, significantly higher early morning (0330-0630 h) and throughout the afternoon (1130-1700 h) in trimester 2, and significantly higher during the evening (2030-2330 h) in trimester 3 in women whose infants were LGA.
  
  
  CONCLUSIONS
  FDA of CGM data identified specific times of day that maternal glucose excursions were associated with LGA. It highlights trimester-specific differences, allowing treatment to be targeted to gestational glucose patterns.
authors.affiliation: Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K. g.r.law@leeds.ac.uk.
authors.forename: Graham R
authors.identifier: http://orcid.org/0000-0001-7904-0264
authors.initials: GR
authors.lastname: Law
authors.affiliation: Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K.
authors.forename: George T H
authors.initials: GT
authors.lastname: Ellison
authors.affiliation: Center for Pregnant Women With Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Secher
authors.affiliation: Center for Pregnant Women With Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Damm
authors.affiliation: Center for Pregnant Women With Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Elisabeth R
authors.initials: ER
authors.lastname: Mathiesen
authors.affiliation: Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, U.K.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Temple
authors.affiliation: Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.
authors.forename: Helen R
authors.initials: HR
authors.lastname: Murphy
authors.affiliation: Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K.
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Scott
mesh_terms: D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring / Q000379:methods; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000097:blood* / Q000453:epidemiology; D005865:Gestational Age; D005947:Glucose; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D005947:Glucose