Abstract: Objective To identify the impact of glucose variability (GV) on the development of gestational hypertension (GH) in patients with gestational diabetes mellitus (GDM), and to find the differences between various GV metrics as well as to evaluate their predictive value in management strategy development. Methods A total of 127 pregnant women diagnosed with GDM were included in this study. After the diagnosis of GDM, continuous glucose monitoring (CGM) and blood pressure measurements were performed, and the occurrence of gestational hypertensive disorders was recorded. Indices of glucose variability were calculated using an automated software EasyGV version 9.0. Results The results revealed an association between gestational hypertension and glucose variability in GDM patients. Among the study participants, 2 cases(1.6%) were diagnosed with preeclampsia and 9 cases(7.1%) were diagnosed with gestational hypertension. TBR% (time below range) showed a significantly negative correlation with diastolic blood pressure at 29-32 weeks of gestation and with both diastolic and systolic blood pressure during delivery. TIR% (time in range) showed a negative correlation with the rate of change in systolic blood pressure between two prenatal visits. CONGA (continuous overlapping net glycemic action) emerged as an independent predictor of gestational hypertension (OR: 3.648; 95% CI: 1.046, 12.721; P=0.042). When CONGA exceeded 4.856, the risk of gestational hypertension in GDM patients increased. Conclusions Blood glucose variation is an independent factor affecting the occurrence of pregnancy-induced hypertension in GDM women. This study suggests new targets for the use and management of CGM in pregnant women with GDM. For GDM patients at high risk of hypertensive disease during pregnancy, blood glucose should be kept at a reasonable and stable level.

Key words: gestational diabetes mellitus, continuous glucose monitoring, glucose variability, preeclampsia, gestational hypertension