Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL.
Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL.
Diabetes Care. 2024 Jan 1;47(1):89-96. doi: 10.2337/dc23-0636.
Continuous glucose monitoring (CGM) improves maternal glycemic control and neonatal outcomes in type 1 diabetes pregnancies compared with self-monitoring of blood glucose. However, CGM targets for pregnancy are based on expert opinion. We aimed to evaluate the association between CGM metrics and perinatal outcomes and identify evidence-based targets to reduce morbidity.
This was a retrospective cohort study of pregnant patients with type 1 or 2 diabetes who used real-time CGM and delivered at a U.S. tertiary center (2018-2021). Multiple gestations, fetal anomalies, and early pregnancy loss were excluded. Exposures included time in range (TIR; 65-140 mg/dL), time above range (TAR), time below range (TBR), glucose variability, average glucose, and glucose management indicator. The primary outcome was a composite of fetal or neonatal mortality, large or small for gestational age at birth, neonatal intensive care unit admission, hypoglycemia, shoulder dystocia or birth trauma, and hyperbilirubinemia. Logistic regression estimated the association between CGM metrics and outcomes, and optimal TIR was calculated.
Of 117 patients, 16 (13.7%) used CGM before pregnancy and 68 (58.1%) had type 1 diabetes. Overall, 98 patients (83.8%) developed the composite neonatal outcome. All CGM metrics, except TBR, were associated with neonatal morbidity. For each 5 percentage-point increase in TIR, there was 28% reduced odds of neonatal morbidity (odds ratio 0.72, 95% CI 0.58-0.89). The statistically optimal TIR was 66-71%.
Nearly all CGM metrics were associated with adverse neonatal morbidity and mortality and may aid management of preexisting diabetes in pregnancy. Our findings support the American Diabetes Association recommendation of 70% TIR.
与自我血糖监测相比，连续血糖监测（CGM）可改善 1 型糖尿病妊娠患者的血糖控制和新生儿结局。然而，妊娠 CGM 目标是基于专家意见制定的。我们旨在评估 CGM 指标与围产结局之间的关系，并确定基于证据的目标以降低发病率。
这是一项在美国三级中心进行的回顾性队列研究，纳入了使用实时 CGM 且分娩的 1 型或 2 型糖尿病孕妇（2018-2021 年）。排除多胎妊娠、胎儿畸形和早期妊娠丢失。暴露因素包括血糖控制达标时间（TIR；65-140mg/dL）、血糖控制不达标时间（TAR）、血糖控制不达标时间（TBR）、血糖变异性、平均血糖和血糖管理指标。主要结局为胎儿或新生儿死亡、出生时大小与胎龄不符、新生儿重症监护病房入院、低血糖、肩难产或分娩创伤、高胆红素血症的复合结局。Logistic 回归估计 CGM 指标与结局之间的关系，并计算最佳 TIR。
在 117 名患者中，16 名（13.7%）在妊娠前使用 CGM，68 名（58.1%）患有 1 型糖尿病。总体而言，98 名患者（83.8%）发生了新生儿复合结局。除 TBR 外，所有 CGM 指标均与新生儿发病率有关。TIR 每增加 5 个百分点，新生儿发病率降低 28%（比值比 0.72，95%CI 0.58-0.89）。统计学上最佳的 TIR 为 66-71%。
几乎所有 CGM 指标均与不良新生儿发病率和死亡率相关，可能有助于管理妊娠前的糖尿病。我们的研究结果支持美国糖尿病协会推荐的 70%TIR。
