Sauer Sara M, Fulcher Isabel, Sanusi Ayodeji, Battarbee Ashley N
Delfina Care, San Francisco, CA (Sauer and Fulcher); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (Sauer).
Delfina Care, San Francisco, CA (Sauer and Fulcher).
Am J Obstet Gynecol MFM. 2025 Jun;7(6):101669. doi: 10.1016/j.ajogmf.2025.101669. Epub 2025 Mar 15.
While time in range (TIR) summarized over pregnancy is associated with adverse outcomes among individuals with preexisting type 1 or 2 diabetes, the impact of TIR trajectories with advancing gestation is unknown.
To identify glucose TIR trajectories across pregnancy and evaluate their association with perinatal outcomes among patients with preexisting diabetes.
Retrospective, single-center cohort study of pregnant patients with type 1 or 2 diabetes who used continuous glucose monitoring (CGM) and delivered in 2019 to 2023. Weekly TIR (65-140 mg/dL) was computed starting at 10 weeks' gestation, and joint latent-class trajectory modeling identified discrete TIR trajectory groups. Patients were classified into groups, and multivariable logistic regression estimated the associations between groups and perinatal outcomes.
Of 179 pregnant patients, 91 had type 1 and 88 had type 2 diabetes. We identified four TIR trajectory groups using data from over 5.1 million CGM measurements: (1) good control, stable (n=48), (2) moderate control, initial improvement, and late decline (n=22), (3) moderate control, late improvement (n=63), and (4) poor control, initial worsening and late improvement (n=46). All perinatal outcomes differed by TIR trajectory. Groups 2, 3, and 4 with suboptimal control in early pregnancy were associated with higher odds of preterm birth, indicated preterm birth, and NICU admission, compared to group 1. Groups 3 and 4, which had the lowest TIR during second and early third trimesters, were associated with higher odds of large-for-gestational-age (LGA). Only group 4 was associated with higher odds of preeclampsia and neonatal hypoglycemia.
Achieving glycemic control in the second and early third trimesters during fetal and placental growth and development is important to reduce the risk of adverse pregnancy outcomes, particularly LGA. Third-trimester TIR decline may impact risk of preterm birth and NICU admission.
虽然孕期总体血糖达标时间（TIR）与已患1型或2型糖尿病个体的不良结局相关，但随着孕周增加TIR轨迹的影响尚不清楚。
确定整个孕期的血糖TIR轨迹，并评估其与已患糖尿病患者围产期结局的关联。
对2019年至2023年使用持续葡萄糖监测（CGM）并分娩的1型或2型糖尿病孕妇进行回顾性单中心队列研究。从妊娠10周开始计算每周的TIR（65 - 140mg/dL），联合潜在类别轨迹模型确定离散的TIR轨迹组。将患者分组，多变量逻辑回归估计组与围产期结局之间的关联。
179名孕妇中，91名患有1型糖尿病，88名患有2型糖尿病。我们使用超过510万次CGM测量数据确定了四个TIR轨迹组：（1）良好控制，稳定（n = 48），（2）中度控制，初期改善，后期下降（n = 22），（3）中度控制，后期改善（n = 63），以及（4）控制不佳，初期恶化，后期改善（n = 46）。所有围产期结局因TIR轨迹而异。与第1组相比，妊娠早期控制不佳的第2、3和4组早产、指征性早产和新生儿重症监护病房（NICU）入院的几率更高。在妊娠中期和妊娠晚期早期TIR最低的第3和4组，与大于胎龄儿（LGA）的几率更高相关。只有第4组与子痫前期和新生儿低血糖的几率更高相关。
在胎儿和胎盘生长发育的妊娠中期和妊娠晚期早期实现血糖控制对于降低不良妊娠结局的风险，尤其是LGA的风险很重要。妊娠晚期TIR下降可能影响早产和NICU入院的风险。
