The Usefulness of CGMS in Identifying and Treating Suboptimal Blood Glucose Patterns in In Vitro Fertilization Pregnancies with Normal OGTT and Increased Amniotic Fluid

IVF pregnancies have an increased incidence of polyhydramnios. Increased amniotic fluid has been considered an indicator to test the mother for Gestational Diabetes Mellitus. Furthermore, IVF pregnancies are associated with a higher prevalence of GDM. In this study, suboptimal BG patterns were detected by CGMS in 19 singleton IVF pregnancies with a 4 quadrant Amniotic Fluid Index (AFI) ≥20cm and a normal OGTT. Clinical characteristics include the following; age: 35±3.7 years, BMI: 25.2±3.8 kg/m2, OGTT: 0’=83.6±7.3, 60’=157.5±19.3, 120’=129±30 mg/dL, HbA1c: 5.3±0.2%, Hadlock (BPD-HC-AC-FL) percentile: 59.7±12.1%, AFI: 21.7±1.6 cm, U/S polyhydramnios confirmation: 21.1±4.7 week. A blind recording of BG patterns was accomplished using a CGMS for 7 days. Mean Sensor BG: 104.2±5 mg/dL, time>120 mg/dL: 221±61 min/24h, time<63 mg/dL: 93.2±81 min, Fasting BG: 90.7±6 mg/dL, 1h-Postprandial BG: 116.6±11 mg/dL, CV: 18.6±3. Mitigation of polyhydramnios was obtained through tight glycemic control using insulin therapy (mean dosage: 32±10.7 IU). Insulin treatment was adjusted to reach the BG target <95 fasting and <120 mg/dL 1-h postprandial. After a treatment duration of 8-weeks, the AFI in 16 of the cases was reduced to less than the 20cm threshold. The decrease noted in the other 3 cases did not reach a level below the 20cm threshold. Pregnancy outcome; Week of delivery: 37.4±1.5, birth weight: 2990±425 g, Small for Gestational age: 2 cases, Large for Gestational age: 1 case, Caesarean Section: 84.2%, there were no cases of congenital malformations. Increased amniotic fluid maybe an indicator of abnormal BG patterns in IVF pregnancies. CGMS is a useful technology to identify suboptimal BG levels which the OGTT may be unable to detect. Timely insulin treatment targeting tight glycemic control could assist in decreasing amniotic fluid. Aggressive and prompt GDM screening in IVF pregnancies is recommended. Disclosure P. Thomakos: None. C. Baretto: None. C. S. Zoupas: None.