Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, U.K.
Norwich Medical School, University of East Anglia, Norwich, U.K.
Diabetes Care. 2022 Aug 1;45(8):1724-1734. doi: 10.2337/dc22-0078.
To determine gestational weekly changes in continuous glucose monitoring (CGM) metrics and 24-h glucose profiles and their relationship to infant birth weight in pregnant women with type 1 diabetes.
An analysis of >10.5 million CGM glucose measures from 386 pregnant women with type 1 diabetes from two international multicenter studies was performed. CGM glucose metrics and 24-h glucose profiles were calculated for each gestational week, and the relationship to normal (10-90th percentile) and large (>90th percentile) for gestational age (LGA) birth weight infants was determined.
Mean CGM glucose concentration fell and percentage of time spent in the pregnancy target range of 3.5-7.8 mmol/L (63-140 mg/dL) increased in the first 10 weeks of pregnancy and plateaued until 28 weeks of gestation, before further improvement in mean glucose and percentage of time in range until delivery. Maternal CGM glucose metrics diverged at 10 weeks of gestation, with significantly lower mean CGM glucose concentration (7.1 mmol/L; 95% CI 7.05-7.15 [127.8 mg/dL; 95% CI 126.9-128.7] vs. 7.5 mmol/L; 95% CI 7.45-7.55 [135 mg/dL; 95% CI 134.1-135.9]) and higher percentage of time in range (55%; 95% CI 54-56 vs. 50%; 95% CI 49-51) in women who had normal versus LGA. The 24-h glucose profiles were significantly higher across the day from 10 weeks of gestation in LGA.
Normal birth weight is associated with achieving significantly lower mean CGM glucose concentration across the 24-h day and higher CGM time in range from before the end of the first trimester, emphasizing the need for a shift in clinical management, with increased focus on using weekly CGM glucose targets for optimizing maternal glycemia from early pregnancy.
确定 1 型糖尿病孕妇连续血糖监测（CGM）指标的妊娠期周变化以及 24 小时血糖谱，并研究其与婴儿出生体重的关系。
对来自两项国际多中心研究的 386 名 1 型糖尿病孕妇的超过 1050 万次 CGM 血糖测量值进行了分析。计算了每个妊娠周的 CGM 血糖指标和 24 小时血糖谱，并确定了其与正常（10-90 百分位）和大（>90 百分位）胎龄（LGA）出生体重婴儿的关系。
在妊娠前 10 周，CGM 血糖浓度下降，妊娠目标范围（3.5-7.8mmol/L，63-140mg/dL）的时间百分比增加，并在 28 孕周前保持稳定，直至分娩前平均血糖和时间百分比进一步改善。母体 CGM 血糖指标在妊娠 10 周时出现差异，CGM 平均血糖浓度明显降低（7.1mmol/L；95%CI 7.05-7.15[127.8mg/dL；95%CI 126.9-128.7]），时间百分比范围升高（55%；95%CI 54-56），而正常与 LGA 相比，50%；95%CI 49-51）。从妊娠 10 周开始，LGA 全天 24 小时血糖谱显著升高。
正常出生体重与妊娠 24 小时内 CGM 平均血糖浓度显著降低和 CGM 时间百分比升高有关，这一现象从妊娠早期开始，这强调了需要转变临床管理模式，将重点更多地放在使用每周 CGM 血糖目标值上，以优化妊娠早期的母体血糖水平。
