A recent study of pregnant women with type 1 diabetes (T1D) found that for every 5 unit increase in time spent in the optimal blood glucose range at 12 weeks of gestation, the risk of preeclampsia decreased by nearly 50%. It turned out to be. When delivering an infant who is over gestational age (LGA).
The study’s time-in-range (TIR) was based on the use of continuous glucose monitoring (CGM), a blood glucose tracking strategy that is becoming more common among pregnant women with T1D, according to the study authors. . The broader use of CGM in this population has also increased interest in the potential association between pregnancy outcomes and CGM parameters, particularly TIR, the researchers wrote in their paper. Journal of the American College of Obstetricians and Gynecologists.
“In 2019, an international expert consensus suggested setting the target time for patients with type 1 diabetes to a range of at least 70% of the entire gestational period. However, this recommendation and clinically relevant perinatal outcomes,” said Nasim C. Sobhani, MD, MAS, assistant professor in the Division of Maternal-Fetal Medicine in the Division of Obstetrics, Gynecology, and Reproduction. write scientists from the University of California, San Francisco. Additionally, the study found that fewer than 30% of participants reached the ideal of a TIR of 70% or higher at each gestational age (GA) level assessed, indicating that “this benchmark is difficult to achieve.” strongly suggests that.
Sobhani et al. conducted a multicenter, retrospective cohort study using data from 91 pregnant women with type 1 diabetes who delivered with continuous glucose monitoring from 2020 to 2022 at five University of California Fetal Consortium facilities.
All women had a continuous blood glucose monitoring target range of 70 mg/dL to 140 mg/dL. The researchers recorded times ranging from 12, 16, 20, 24, 28, and 32 weeks.
The primary maternal outcome was preeclampsia and the primary neonatal outcome was LGA.
The average age of participants was 32.6 years. Approximately two-thirds (67%) identified as non-Hispanic white and 14% as Hispanic. His median HbA1c before and after conception was 6.7% (range 5.8–7.6%). In this cohort, 81% of women were using insulin pumps, and 72% did not have diabetes-related microvascular disease. The median time since type 1 diabetes diagnosis was 16 years.
Investigation result
Overall, 29% of women developed preeclampsia. Compared to these women, normotensive participants recorded higher times in range at nearly all GA time points (56%–62% vs. 43%–50%).
Twenty-six percent of women had infants rated LGA. As observed for preeclampsia outcomes, women with normal birth weight infants had higher she-TIRs of 55% to 64%, and women with LGA infants had she-TIRs of 41% to 47%.
Sobhani et al. found that as early as 12 weeks of gestation, each 5-unit increase in TIR was associated with a 45% reduction in the risk of preeclampsia (adjusted RR = 0.55, 95% CI, 0.3-0.99); They reported a 46% reduction in risk. Risk for LGA infants in adjusted analysis (aRR = 0.54; 95% CI, 0.29-0.99).
“These findings provide important preliminary data to guide detailed patient counseling in clinical practice. Rather than dichotomize TIR as above or below a particular benchmark, physicians should “[T]he authors write in discussing the clinical significance of their findings,” the authors wrote, when discussing the clinical significance of their findings. More importantly, Sobhani et al. said, “it can provide reassurance to medical teams that even small improvements in TIR can have a substantial impact on clinical outcomes.”
