Department of Reproduction, Poznan University of Medical Sciences, Poznań, Poland; Department of Histology and Embryology, Poznan University of Medical Sciences, Poznań, Poland; Doctoral School, Poznan University of Medical Sciences, Poznań, Poland.
Department of Reproduction, Poznan University of Medical Sciences, Poznań, Poland
Pol Arch Intern Med. 2023 Nov 29;133(11). doi: 10.20452/pamw.16501. Epub 2023 May 22.
Continuous glucose monitoring (CGM) improves pregnancy outcomes in patients with type 1 diabetes (T1D).
The primary study objective was to analyze associations between numerous novel CGM parameters and neonatal complications, such as large‑for‑gestational‑age (LGA) neonates, hypoglycemia, hyperbilirubinemia, transient breathing disorders, preterm births, as well as pre‑eclampsia.
In this single‑center retrospective cohort study, we recruited 102 eligible pregnant women with T1D who were treated with sensor‑augmented pumps with suspend‑before‑low function from the first trimester. The pregnant patients were admitted for at least 1 control hospital visit in each trimester of gestation for anthropometric and laboratory measurements and collection of sensor data.
The median (interquartile range) percentage values for glycated hemoglobin (HbA1c) (first trimester, 6.23 [5.91-6.9]; second trimester, 5.49 [5.16-5.9]; third trimester, 5.75 [5.39-6.29]) and for time‑in‑range (first trimester, 72.4 [67.3-80.3]; second trimester, 72.5 [64.7-79.6]; third trimester, 75.9 [67.1-81.4] met the criteria of well‑controlled T1D in each trimester of pregnancy. Nonetheless, we noted 27% of LGA births, 25% of neonatal hypoglycemia, 33% of hyperbilirubinemia, and 13% of preterm births. Worse glycemic control and more glycemic fluctuations in the second and third trimesters were mainly associated with increased risk of LGA at birth, transient breathing disorders, and hyperbilirubinemia.
CGM parameters (mean of daily differences, high blood glucose index, glycemic risk assessment in diabetes equation, or continuous overall net glycemic action) in the patients with T1D are significantly associated with the increased risk of LGA at birth and neonatal transient breathing disorders and hyperbilirubinemia. However, we did not find evidence that novel CGM indices could be more effective in predicting those events than the commonly used CGM parameters or HbA1c levels.
连续血糖监测（CGM）可改善 1 型糖尿病（T1D）患者的妊娠结局。
主要研究目的是分析多种新型 CGM 参数与新生儿并发症（如巨大儿、低血糖、高胆红素血症、短暂呼吸障碍、早产以及子痫前期）之间的关联。
在这项单中心回顾性队列研究中，我们招募了 102 名接受具有低血糖暂停前功能的传感器增强型泵治疗的 T1D 孕妇，从妊娠早期开始。这些孕妇至少在每个妊娠阶段进行 1 次就诊，进行人体测量和实验室检查，并收集传感器数据。
糖化血红蛋白（HbA1c）中位数（四分位距）值（妊娠早期，6.23[5.91-6.9]；妊娠中期，5.49[5.16-5.9]；妊娠晚期，5.75[5.39-6.29]）和达标时间比例中位数（72.4[67.3-80.3]）（妊娠早期；72.5[64.7-79.6]；妊娠晚期；75.9[67.1-81.4]）均符合妊娠各阶段 T1D 控制良好的标准。然而，我们发现 27%的巨大儿分娩、25%的新生儿低血糖、33%的高胆红素血症和 13%的早产。妊娠中期和晚期血糖控制更差且血糖波动更大，主要与出生时巨大儿、短暂呼吸障碍和高胆红素血症的风险增加有关。
T1D 患者的 CGM 参数（平均每日差异、高血糖指数、糖尿病方程中的血糖风险评估或连续总体净血糖作用）与出生时巨大儿的风险增加以及新生儿短暂呼吸障碍和高胆红素血症显著相关。然而，我们没有发现新的 CGM 指数在预测这些事件方面比常用的 CGM 参数或 HbA1c 水平更有效。
