Fishel Bartal Michal, Nazeer Sarah A, Ashby Cornthwaite Joycelyn, Bitar Ghamar, Blackwell Sean C, Pedroza Claudia, Chauhan Suneet P, Saad Antonio, Saade George, Sibai Baha M
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Perinatol. 2025 Jul;42(10):1344-1353. doi: 10.1055/a-2494-2157. Epub 2024 Dec 2.
We aimed to evaluate the relationship between intrapartum continuous glucose monitoring (CGM) and neonatal hypoglycemia (NH) in individuals with diabetes.a multicenter prospective study (November 2021-December 2022) of laboring individuals with pregestational or gestational diabetes at ≥34 weeks. Cohorts had a blinded CGM placed from admission through delivery and were monitored with fingerstick (FS) according to usual care. The primary outcome was NH. Secondary neonatal outcomes included neonatal intensive care unit (NICU) length of stay, need for intravenous (IV) glucose therapy, hyperbilirubinemia, respiratory distress, or respiratory distress syndrome. Time in the target range (TIR; range 70-110 mg/dL) and time above the target range (TAR; >110 mg/dL) were expressed as a percentage of all CGM readings, and mean glucose was obtained. Youden index was used to choose the cut point for TAR and prediction of NH.Of 9,479 deliveries during the study period, 202 (2.1%) met the inclusion criteria, and 112 (56%) participants were enrolled ( = 7 did not have available CGM data). Of the study participants, 45 (40%) had pregestational diabetes, and 67 (60%) had gestational diabetes. The mean glucose in labor using a CGM was 102.6 mg/dL (interquartile range [IQR]:89.9, 113.5 mg/dL), and the average percentage of TIR was 62.1% (IQR, 36.9, 85.6). CGM and FS were poor predictors of NH, with no differences in area under the curve (AUC) of mean glucose as a predictor (0.64, 95% CI: 0.48-0.23 vs. 0.53, 95% CI: 0.4-0.6, respectively). The best cut-off for the prediction of NH was a TAR of 61%, with 23% ( = 24) being above the threshold. The rate of NH for TAR >61% versus ≤61% was 45.8 versus 25.9% ( = 0.06). Neonates born to individuals with TAR >61% were more likely to require continuous positive airway pressure after delivery and had a higher cord c-peptide level.In this prospective study of laboring individuals with diabetes, intrapartum CGM TAR was associated with a higher rate of NH. · CGM use in labor is feasible with a complete glucose profile in the various stages of labor.. · Best cut-off for predicting NH was a time above range (≥110 mg/dL) of >61%.. · CGM and FS were poor predictors of NH..
我们旨在评估糖尿病患者分娩期间连续血糖监测（CGM）与新生儿低血糖（NH）之间的关系。这是一项多中心前瞻性研究（2021年11月至2022年12月），研究对象为孕周≥34周的孕前或孕期糖尿病分娩女性。研究队列从入院至分娩期间佩戴盲法CGM，并按照常规护理进行指尖血糖（FS）监测。主要结局为NH。次要新生儿结局包括新生儿重症监护病房（NICU）住院时间、静脉（IV）葡萄糖治疗需求、高胆红素血症、呼吸窘迫或呼吸窘迫综合征。目标范围内时间（TIR；范围70 - 110mg/dL）和高于目标范围时间（TAR；>110mg/dL）以所有CGM读数的百分比表示，并计算平均血糖。使用约登指数选择TAR的切点并预测NH。在研究期间的9479例分娩中，202例（2.1%）符合纳入标准，112例（56%）参与者被纳入研究（7例没有可用的CGM数据）。在研究参与者中，45例（40%）有孕前糖尿病，67例（60%）有孕期糖尿病。分娩期间使用CGM测得的平均血糖为102.6mg/dL（四分位数间距[IQR]：89.9，113.5mg/dL），TIR的平均百分比为62.1%（IQR，36.9，85.6）。CGM和FS对NH的预测能力较差，作为预测指标的平均血糖曲线下面积（AUC）无差异（分别为0.64，95%CI：0.48 - 0.23 vs. 0.53，95%CI：0.4 - 0.6）。预测NH的最佳切点是TAR为61%，23%（n = 24）高于该阈值。TAR>61%与≤61%的NH发生率分别为45.8%和25.9%（P = 0.06）。TAR>61%的个体所生新生儿出生后更有可能需要持续气道正压通气，且脐血C肽水平更高。在这项针对糖尿病分娩女性的前瞻性研究中，分娩期间CGM的TAR与较高的NH发生率相关。·分娩期间使用CGM是可行的，可获得分娩各阶段完整的血糖情况。·预测NH的最佳切点是高于范围（≥110mg/dL）的时间>61%。·CGM和FS对NH的预测能力较差。
