Higher mean amplitude of glycaemic excursion in the second trimester of
pregnancy is associated with the subsequent development of gestational
diabetes mellitus: an observational study
Abstract
Objective: To examine glycaemic variability (GV) and glycaemic control
(GC) parameters in early pregnancy with subsequent development of
gestational diabetes mellitus (GDM). Design: Longitudinal observational
study. Setting: Pregnant women from KK Women and Children’s Hospital in
Singapore Participants: 51 study participants in the first trimester
(9-13 weeks’ gestational), and 44 participants (18-23 weeks’ gestation)
in the second trimester of pregnancy. Methods: Independent t-tests were
used to examine the differences in the parameters between participants
who developed GDM and those who did not. Main outcome measure: GDM was
determined at 24-30 weeks’ gestation using oral glucose tolerance test
(OGTT). GV parameters examined were, mean amplitude of glycaemic
excursion (MAGE), standard deviation of blood glucose (SDBG) and mean of
daily continuous 24 h blood glucose (MBG) and coefficient of variation
(CV). GC parameters measured were, J-Index and % time spent in glucose
target ranges. Results: In the second trimester of pregnancy, mean
amplitude of glycaemic excursions (MAGE) was significantly higher in
participants who subsequently developed GDM, compared to those who did
not (mean (SD): 3.18(0.68) vs 2.60(0.53), p=0.02). Other study
parameters measured in the second trimester of pregnancy were not
significantly different between groups. There were no significant
associations between all the GV and GC parameters determined from the
CGM in the first trimester with subsequent development of GDM
(p>0.05). Conclusion: MAGE is an important GV parameter
associated to the development of subsequent GDM in pregnant women. The
findings highlight the potential value of CGM in gestational glycaemic
profiling.