Bitar Ghamar, Cornthwaite Joycelyn A, Sadek Sandra, Ghorayeb Tala, Daye Nahla, Nazeer Sarah, Ghafir Danna, Cornthwaite John, Chauhan Suneet P, Sibai Baha M, Fishel Bartal Michal
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
Department of Earth, Environmental and Planetary Science, Rice University, Houston, Texas.
Am J Perinatol. 2024 May;41(S 01):e1370-e1377. doi: 10.1055/s-0043-1764208. Epub 2023 Mar 1.
Continuous glucose monitoring (CGM) has become available for women with type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM) during pregnancy. The recommended time in range (TIR, blood glucose 70-140 mg/dL) and its correlation with adverse pregnancy outcomes in this group is unknown. Our aim was to compare maternal and neonatal outcomes in pregnant people with T2DM or GDM with average CGM TIR values >70 versus ≤70%.
We conducted a retrospective cohort study of all individuals using CGM during pregnancy from January 2017 to June 2022. Individuals with type 1 diabetes mellitus, or those missing CGM or delivery data were excluded. Primary composite neonatal outcome included any of the following: large for gestational age, NICU admission, need for intravenous glucose, respiratory support, or neonatal death. Secondary outcomes included other maternal and neonatal outcomes. Regression models were used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI).
During the study period, 141 individuals with diabetes utilized CGM during pregnancy, with 65 (46%) meeting inclusion criteria. Of the study population, 28 (43%) had TIR ≤70% and 37 (57%) had TIR > 70%. Compared with those with TIR > 70%, the primary composite outcome occurred more frequently in neonates of individuals TIR ≤70% (71.4 vs. 37.8%, aOR: 4.8, 95% CI: 1.6, 15.7). Furthermore, individuals with TIR ≤70% were more likely to have hypertensive disorders (42.9 vs. 16.2%, OR: 3.9, 95% CI: 1.3, 13.0), preterm delivery (54 vs. 27%, OR: 3.1, 95% CI: 1.1, 9.1): , and cesarean delivery (96.4 vs. 51.4%, OR: 4.6, 95% CI: 2.2, 15.1) compared with those with TIR >70%.
Among people with T2DM or GDM who utilized CGM during pregnancy, 4 out 10 individuals had TIR ≤70% and, compared with those with TIR > 70%, they had a higher likelihood of adverse neonatal and maternal outcomes.
· Time in range can be utilized as a metric for pregnant patients using continuous glucose monitor.. · Time in range >70% is achievable by 6 out of 10 patients.. · Time in range below goal is associated with adverse neonatal and maternal outcomes..
连续血糖监测（CGM）现已应用于患有2型糖尿病（T2DM）或妊娠期糖尿病（GDM）的孕妇。该人群中推荐的血糖在目标范围内的时间（TIR，血糖70 - 140mg/dL）及其与不良妊娠结局的相关性尚不清楚。我们的目的是比较平均CGM TIR值>70%与≤70%的T2DM或GDM孕妇的母婴结局。
我们对2017年1月至2022年6月期间所有在孕期使用CGM的个体进行了一项回顾性队列研究。排除1型糖尿病患者或缺少CGM或分娩数据的个体。主要复合新生儿结局包括以下任何一项：大于胎龄儿、入住新生儿重症监护病房、需要静脉输注葡萄糖、呼吸支持或新生儿死亡。次要结局包括其他母婴结局。使用回归模型估计调整后的优势比（aOR）和95%置信区间（CI）。
在研究期间，141例糖尿病患者在孕期使用了CGM，其中65例（46%）符合纳入标准。在研究人群中，28例（43%）的TIR≤70%，37例（57%）的TIR>70%。与TIR>70%的个体相比，TIR≤70%的个体的新生儿主要复合结局更频繁发生（71.4%对37.8%，aOR：4.8，95%CI：1.6，15.7）。此外，TIR≤70%的个体更有可能患有高血压疾病（42.9%对16.2%，OR：3.9，95%CI：1.3，13.0）、早产（54%对27%，OR：3.1，95%CI：1.1，9.1）以及剖宫产（96.4%对51.4%，OR：4.6，95%CI：2.2，15.1）。
在孕期使用CGM的T2DM或GDM患者中，十分之四的个体TIR≤70%，与TIR>70%的个体相比，他们出现不良新生儿和母亲结局的可能性更高。
·血糖在目标范围内的时间可作为使用连续血糖监测仪的孕妇的一个指标。·十分之六的患者可实现血糖在目标范围内的时间>70%。·血糖在目标范围以下的时间与不良新生儿和母亲结局相关。
