Glucose time in range trajectories during pregnancy and association with adverse perinatal outcomes: a joint latent-class trajectory modeling approach

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm Pub Date : 2025-03-15 DOI:10.1016/j.ajogmf.2025.101669

Sara M. Sauer PhD , Isabel Fulcher PhD , Ayodeji Sanusi MD , Ashley N. Battarbee MD

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引用次数: 0

Abstract

Background

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.

Objective

To identify glucose TIR trajectories across pregnancy and evaluate their association with perinatal outcomes among patients with preexisting diabetes.

Study Design

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.

Results

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.

Conclusion

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.

查看原文本刊更多论文

妊娠期间葡萄糖时间范围轨迹及其与不良围产期结局的关联：一种联合潜在类轨迹建模方法。

背景：虽然妊娠期间总结的范围内时间（TIR）与既往存在的1型或2型糖尿病患者的不良结局有关，但TIR轨迹对妊娠晚期的影响尚不清楚。目的：确定妊娠期间葡萄糖TIR轨迹，并评估其与既往糖尿病患者围产期结局的关系。研究设计：回顾性、单中心队列研究，对2019-2023年分娩的1型或2型糖尿病孕妇进行持续血糖监测。从妊娠10周开始计算每周TIR (65-140 mg/dL)，联合潜伏级轨迹模型确定离散TIR轨迹组。患者被分为不同的组，多变量logistic回归估计组与围产儿结局之间的关联。结果：179例妊娠患者中，1型糖尿病91例，2型糖尿病88例。我们使用超过510万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，初始改善和后期下降（n=22）， 3)中度控制，后期改善（n=63）， 4)不良控制，初始恶化和后期改善（n=46）。所有围产儿结局因TIR轨迹而异。与第1组相比，第2、3和4组妊娠早期控制不佳的患者发生早产、预示性早产和入住新生儿重症监护病房的几率更高。第3组和第4组在妊娠中期和晚期早期的TIR最低，与LGA的几率较高相关。只有第4组与较高的先兆子痫和新生儿低血糖相关。结论：在胎儿和胎盘生长发育期间，在妊娠中期和早期晚期控制血糖对于降低不良妊娠结局，特别是LGA的风险非常重要。妊娠晚期TIR下降可能影响早产和新生儿重症监护病房入院的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Obstetrics & Gynecology Mfm Medicine-Medicine (all)

CiteScore

7.40

自引率

3.20%

发文量

254

审稿时长

40 days

期刊介绍： The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.