Rademaker Doortje, van der Wel Anne W T, van Eekelen Rik, Voormolen Daphne N, de Valk Harold W, Evers Inge M, Mol Ben Willem, Franx Arie, Siegelaar Sarah E, van Rijn Bas B, DeVries J Hans, Painter Rebecca C
Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands.
Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands.
Diabetes Obes Metab. 2023 Dec;25(12):3798-3806. doi: 10.1111/dom.15276. Epub 2023 Sep 21.
To investigate the association between continuous glucose monitoring (CGM) metrics and perinatal outcomes in insulin-treated diabetes mellitus in pregnancy.
In a post-hoc analysis of the GlucoMOMS randomized controlled trial, we investigated the association between the metrics of an offline, intermittent CGM, glycated haemoglobin (HbA1c) and perinatal outcomes per trimester in different types of diabetes (type 1, 2 or insulin-treated gestational diabetes mellitus [GDM]). Data were analysed using multivariable binary logistic regression. Outcomes of interest were neonatal hypoglycaemia, pre-eclampsia, preterm birth, large for gestational age (LGA) and Neonatal Intensive Care Unit (NICU) admission. The glucose target range was defined as 3.5-7.8 mmol/L (63-140 mg/dL).
Of the 147 participants (N = 50 type 1 diabetes, N = 94 type 2 diabetes/insulin-treated GDM) randomized to the CGM group of the GlucoMOMS trial, 115 participants had CGM metrics available and were included in the current study. We found that, in pregnancies with type 1 diabetes, a higher second trimester mean glucose was associated with LGA (odds ratio 2.6 [95% confidence interval 1.1-6.2]). In type 2 and insulin-treated gestational diabetes, an increased area under the curve above limit was associated with LGA (odds ratio 10.0 [95% confidence interval 1.4-72.8]). None of the CGM metrics were associated with neonatal hypoglycaemia, pre-eclampsia, shoulder dystocia, preterm birth and NICU admission rates for pregnancies complicated by any type of diabetes.
In this study, in type 2 diabetes or insulin-treated GDM, the glucose increased area under the curve above limit was associated with increased LGA. In type 1 diabetes, the mean glucose was the major determinant of LGA. Our study found no evidence that other CGM metrics determined adverse pregnancy outcomes.
探讨持续葡萄糖监测（CGM）指标与妊娠合并胰岛素治疗的糖尿病患者围产期结局之间的关联。
在对GlucoMOMS随机对照试验的事后分析中，我们研究了离线间歇性CGM指标、糖化血红蛋白（HbA1c）与不同类型糖尿病（1型、2型或胰岛素治疗的妊娠期糖尿病[GDM]）各孕期围产期结局之间的关联。使用多变量二元逻辑回归分析数据。感兴趣的结局包括新生儿低血糖、子痫前期、早产、大于胎龄儿（LGA）和新生儿重症监护病房（NICU）入院。血糖目标范围定义为3.5 - 7.8 mmol/L（63 - 140 mg/dL）。
在GlucoMOMS试验中，随机分配至CGM组的147名参与者（50例1型糖尿病，94例2型糖尿病/胰岛素治疗的GDM）中，115名参与者有可用的CGM指标并纳入本研究。我们发现，在1型糖尿病妊娠中，孕中期平均血糖较高与LGA相关（优势比2.6[95%置信区间1.1 - 6.2]）。在2型和胰岛素治疗的妊娠期糖尿病中，曲线下面积超过上限增加与LGA相关（优势比10.0[95%置信区间1.4 - 72.8]）。对于任何类型糖尿病合并妊娠的新生儿低血糖、子痫前期、肩难产、早产和NICU入院率，CGM指标均无关联。
在本研究中，在2型糖尿病或胰岛素治疗的GDM中，曲线下面积超过上限的血糖升高与LGA增加相关。在1型糖尿病中，平均血糖是LGA的主要决定因素。我们的研究没有发现其他CGM指标决定不良妊娠结局的证据。
