SAT164 Hypoglycemia Risk And Glucose Parameters In Pregnant Women With Or Without Diabetes During Fasting Ramadan
Authors: Alamoudi Reem Mohammad , Theyab Abeer , Shams Taghreed , Alhashemi Hashem 
Published: October 2023

Abstract
Disclosure: R.M. Alamoudi: None. A. Theyab: None. T. Shams: None. H. Alhashemi: None.
Background: Pregnancy increases the risk of fasting hypoglycemia and is considered an exemption for fasting during Ramadan. Glucose patterns and hypoglycemia risk in relation to fasting Ramadan in pregnant women are not well studied. Objectives: To compare the risk of hypoglycemia, glucose patterns, and tolerance of fasting in pregnant women with gestational diabetes (GDM) versus women without GDM during fasting Ramadan. Methods: A prospective observational study conducted in the Obstetrics/Endocrine clinics at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Pregnant women without GDM, and with GDM managed by diet or metformin, who were planning on fasting Ramadan and were dedicated to applying a flash glucose monitoring (CGM) device for two weeks were recruited. Women with GDM received standard-of-care diabetes education regarding fasting during Ramadan. Participation was entirely voluntary. Results: 30 women with gestational age ≥ 24 weeks completed the study; 8 without GDM (Gp. 1), 16 with GDM on diet (Gp. 2), and 6 with GDM on metformin (Gp. 3). Mean demographics respectively: Age 30.13 ±4.9 vs. 33.56 ±6.4 vs. 34.50 ±5.8 (p=0.2), BMI 34.36 ±5.88 vs. 30.74 ±3.75 vs. 36.75 ±8.01 (p=0.4), Gravida 3 ±2.2 vs. 3.38 ± 2.48 vs. 4.33 ±2.88 (p=0.6). Breaking Ramadan fasting was reported in 13 (43%) of all participants; 3 (37.5%) vs. 6 (37.5%) vs. 4 (66.7%), respectively. The median (IQR) days fast broken were 2 vs 2 (4) vs 1 (11) days, p=0.2, with the reason being hypoglycemia in 1 vs 4 vs 2, and hyperglycemia in 0 vs 1 vs 2, the other reasons included fatigue and acute illness, p=0.3. The average hypoglycemia glucose reading in mg/dl (M± S.D) associated with breaking the fast was 56 ±4.8, p=0.54. The usual timing of hypoglycemia was late evening, while for hyperglycemia it was post-midnight meal followed by post-Suhoor (predawn meal). Ambulatory glucose profile (AGP) parameters per 450 patient days for the three groups respectively: Average glucose (mg/dl) (median - IQR) 89 (13) vs. 95 (24) vs. 103 (34), p=0.3, Time spent within range (BG 63-140 mg/dl) 87 (6)% vs. 81 (16)% vs. 80 (44) %, p=0.1, Glucose management indicator (M ±S.D) 5.4 ±0.2%, 5.6 ±0.4%, 5.5 ±0.3%, p=0.5, and Glucose variability 17.6 ±1.9%, 20.8 ±2.9%, 24.7 ±11.5%, p=0.07. Time spent above range (BG &gt;140 mg/dl) 7 ±6% vs. 18 ±19% vs. 25 ±26%, p=0.2, Time spent below range (BG &lt;63 mg/dl) 8 ±8% vs. 7 ±8% vs. 10 ±21%, p=0.8, and Duration spent in hypoglycemia (minutes) 90 ±117.4, 65.8 ±61.1, 70 ±108.03, p=0.8. CGM-detected hypoglycemic events (BG &lt;63 mg/dl) were found in 20 (66.7%) of all participants, the average number of events (median-IQR) per group was: 4 (5) vs. 6 (8) vs. 1 (15), p=0.8. Conclusion: Pregnant women with non-insulin-treated GDM compared to those without GDM experienced similar difficulties in tolerating fasting during Ramadan and increased risk of hypoglycemia. The potential perinatal harm needs more research. ClinicalTrials.gov NCT04862390
Presentation: Saturday, June 17, 2023