ATTD Yearbook 2021 - Chapter 6 - Technology and Pregnancy

Authors: Jennifer M. Yamamoto and Helen R. Murphy
Presented at #ATTD2022

The manuscripts chosen for this yearbook address key controversies in the screening and detection of gestational diabetes mellitus (GDM), glycemic metrics using intermittent and continuous glucose monitoring (CGM) in type 1 diabetes and the theory of beta‐cell regeneration.

GDM diagnostic criteria were initially established over 50 years ago to identify women at high risk for the development of diabetes after pregnancy. Over the past 20 years, the emphasis has switched more to identifying women and their offspring at increased risk of obstetric and neonatal complications. The 2000–2006 Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study found that oral glucose tolerance tests (OGTT) measures were continuously associated with cord‐blood C‐peptide, large‐for‐gestational‐age, birth weight, cesarean delivery (one standard deviation rise in glucose increased primary cesarean delivery by 8%–11%) and clinically relevant neonatal hypoglycemia (although rates were low at approximately 2%).

The observational study design, lack of glycemic thresholds for risk, and the fact that these outcomes are not all clinically relevant has challenged translation into clinical practice. Two studies which sought to inform approaches for GDM screening and diagnosis are included.