在无并发症妊娠中使用连续葡萄糖监测仪测量血糖水平。

IF 3.7 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

BMJ Open Diabetes Research & Care Pub Date : 2024-05-10 DOI:10.1136/bmjdrc-2023-003989

Anders L Carlson, Roy W Beck, Zoey Li, Elizabeth Norton, Richard M Bergenstal, Mary Johnson, Sean Dunnigan, Matthew Banfield, Katie J Krumwiede, Judy R Sibayan, Peter Calhoun, Celeste Durnwald

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引用次数: 0

摘要

导言研究设计和方法：两个研究机构共招募了 937 名年龄在 17 孕周之前的 18 岁及以上的孕妇；其中 413 人属于无并发症妊娠（平均±标准体重指数（BMI）为 25.3±5.0 kg/m2），并在整个妊娠期佩戴 Dexcom G6 连续血糖监测（CGM）设备。进餐时间均自愿记录。使用 CGM 测量的血糖指标来描述妊娠期间的血糖水平：结果：参与者每人佩戴 CGM 的时间中位数为 123 天。在无并发症妊娠的三个孕期中，血糖水平基本稳定。妊娠期血糖总体平均值（±SD）为 98±7 mg/dL (5.4±0.4 mmol/L)，63-120 mg/dL (3.5-6.7 mmol/L)中位时间占 86%（IQR：82-89%），120 mg/dL (6.7 mmol/L)中位时间占 11%，140 mg/dL (7.8 mmol/L)中位时间占 2.5%。餐后血糖峰值的平均值为 126±22 mg/dL (7.0±1.2 mmol/L)，餐后血糖偏移的平均值为 36±22 mg/dL (2.0±1.2 mmol/L)。较高的平均血糖水平与体重指数（BMI）较高的孕妇呈低至中度相关（BMI ≥30.0 kg/m2 为 103±6 mg/dL (5.7±0.3 mmol/L) vs BMI 18.5-2 为 96±7 mg/dL (5.3±0.4 mmol/L)，r=0.35）：平均血糖水平和时间 63-120 毫克/分升（3.5-6.7 毫摩尔/升）在整个孕期几乎保持稳定，高于 140 毫克/分升（7.8 毫摩尔/升）的情况很少见。随着体重指数（BMI）上升到超重/肥胖范围，孕期平均血糖水平呈上升趋势。无并发症妊娠期间报告的血糖指标代表了孕妇的治疗目标。

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Glucose levels measured with continuous glucose monitoring in uncomplicated pregnancies.

Introduction: To characterize glucose levels during uncomplicated pregnancies, defined as pregnancy with a hemoglobin A1c <5.7% (<39 mmol/mol) in early pregnancy, and without a large-for-gestational-age birth, hypertensive disorders of pregnancy, or gestational diabetes mellitus (ie, abnormal oral glucose tolerance test).

Research design and methods: Two sites enrolled 937 pregnant individuals aged 18 years and older prior to reaching 17 gestational weeks; 413 had an uncomplicated pregnancy (mean±SD body mass index (BMI) of 25.3±5.0 kg/m²) and wore Dexcom G6 continuous glucose monitoring (CGM) devices throughout the observed gestational period. Mealtimes were voluntarily recorded. Glycemic levels during gestation were characterized using CGM-measured glycemic metrics.

Results: Participants wore CGM for a median of 123 days each. Glucose levels were nearly stable throughout all three trimesters in uncomplicated pregnancies. Overall mean±SD glucose during gestation was 98±7 mg/dL (5.4±0.4 mmol/L), median per cent time 63-120 mg/dL (3.5-6.7 mmol/L) was 86% (IQR: 82-89%), median per cent time <63 mg/dL (3.5 mmol/L) was 1.8%, median per cent time >120 mg/dL (6.7 mmol/L) was 11%, and median per cent time >140 mg/dL (7.8 mmol/L) was 2.5%. Mean post-prandial peak glucose was 126±22 mg/dL (7.0±1.2 mmol/L), and mean post-prandial glycemic excursion was 36±22 mg/dL (2.0±1.2 mmol/L). Higher mean glucose levels were low to moderately associated with pregnant individuals with higher BMIs (103±6 mg/dL (5.7±0.3 mmol/L) for BMI ≥30.0 kg/m² vs 96±7 mg/dL (5.3±0.4 mmol/L) for BMI 18.5-<25 kg/m², r=0.35).

Conclusions: Mean glucose levels and time 63-120 mg/dL (3.5-6.7 mmol/L) remained nearly stable throughout pregnancy and values above 140 mg/dL (7.8 mmol/L) were rare. Mean glucose levels in pregnancy trend higher as BMI increases into the overweight/obesity range. The glycemic metrics reported during uncomplicated pregnancies represent treatment targets for pregnant individuals.

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来源期刊

BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

9.30

自引率

2.40%

发文量

123

审稿时长

18 weeks

期刊介绍： BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.