1型糖尿病妇女的母体和胎儿结局与瞬时血糖监测指标相关：一项队列研究

IF 1.9 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Endocrinologia Diabetes Y Nutricion Pub Date : 2026-08-01 Epub Date: 2026-09-15 DOI:10.1016/j.endien.2026.501804

Gema López-Gallardo, Ana Piñar-Gutiérrez, Celia Hernández-Reina, Sandra Amuedo, Noelia Gros-Herguido, Pablo J. Remón-Ruiz, Virginia Bellido, Pilar Santa Cruz-Álvarez, Lucas Cerrillo, Alfonso Soto-Moreno

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引用次数: 0

摘要

目的探讨妊娠1型糖尿病（T1DM）患者瞬时血糖监测（FGM）指标与围产儿结局的关系。研究设计和方法本回顾性队列研究纳入了接受过女性生殖器切割的T1DM孕妇。主要终点是一个复合终点，包括胎儿或新生儿死亡率、大胎龄（LGA）出生体重、新生儿重症监护病房（NICU）入院或新生儿低血糖。评估糖化血红蛋白（HbA1c）水平，以及妊娠特异性葡萄糖靶标的范围内时间（TIR）、范围内时间（TBR）和范围内时间（TAR），以及葡萄糖变异性。结果共纳入70例女性，中位年龄36岁（IQR, 31-38），体重指数（BMI） 27±5 kg/m2，糖尿病病程20±8年，妊娠HbA1c 7.3±1.4%。其中吸烟占21.7%，高血压占4.5%，血脂异常占10.1%，糖尿病视网膜病变占41.2%。经历复合终点的妇女在所有妊娠期间均表现出明显较低的TIR和较高的TAR，妊娠早期（1T）和晚期（3T）的血糖变异性（CV）较大，妊娠晚期的血糖管理指标（GMI）较高。Logistic回归分析显示，妊娠中期（2T） TIR <； 69.5%使复合终点的风险增加10.56倍（P = 0.015）。同样，妊娠早期CV≥31.85%与6.42倍的风险增加相关（P = 0.039）。结合这两个变量的模型灵敏度为94.3%，特异性为50%。结论：通过FGM指标评估的血糖控制，特别是妊娠中期的TIR和妊娠早期的CV，与T1DM孕妇的不良母胎结局有关。

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Maternal and fetal outcomes associated with flash glucose monitoring metrics in women with type 1 diabetes: A cohort study

Objective

To evaluate the association between flash glucose monitoring (FGM) metrics and perinatal outcomes in pregnant women with type 1 diabetes (T1DM).

Research design and methods

This retrospective cohort study included pregnant women with T1DM who used FGM. The primary outcome was a composite endpoint including fetal or neonatal mortality, large-for-gestational-age (LGA) birth weight, neonatal intensive care unit (NICU) admission, or neonatal hypoglycemia. Glycated hemoglobin (HbA1c) levels were assessed together with time in range (TIR), time below range (TBR), and time above range (TAR) within pregnancy-specific glucose targets, as well as glucose variability.

Results

A total of 70 women were included, with a median age of 36 years (IQR, 31–38), body mass index (BMI) 27 ± 5 kg/m², diabetes duration 20 ± 8 years, and pregestational HbA1c 7.3 ± 1.4%. Among them, 21.7% were smokers, 4.5% had hypertension, 10.1% had dyslipidemia, and 41.2% had diabetic retinopathy. Women who experienced the composite endpoint exhibited significantly lower TIR and higher TAR across all trimesters, greater glycemic variability (CV) during the first (1T) and third trimesters (3T), and a higher glucose management indicator (GMI) in the third trimester. Logistic regression analysis showed that a TIR < 69.5% during the second trimester (2T) increased the risk of the composite endpoint by 10.56-fold (P = .015). Similarly, CV ≥ 31.85% during the first trimester was associated with a 6.42-fold increased risk (P = .039). A model combining these 2 variables achieved a sensitivity of 94.3% and a specificity of 50%.

Conclusions

Glycemic control assessed through FGM metrics, particularly TIR during the second trimester and CV during the first trimester, is associated with adverse maternal–fetal outcomes in pregnant women with T1DM.

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来源期刊

Endocrinologia Diabetes Y Nutricion Multiple-

CiteScore

2.10

自引率

10.50%

发文量

期刊介绍： Endocrinología, Diabetes y Nutrición is the official journal of the Spanish Society of Endocrinology and Nutrition (Sociedad Española de Endocrinología y Nutrición, SEEN) and the Spanish Society of Diabetes (Sociedad Española de Diabetes, SED), and was founded in 1954. The aim of the journal is to improve knowledge and be a useful tool in practice for clinical and laboratory specialists, trainee physicians, researchers, and nurses interested in endocrinology, diabetes, nutrition and related disciplines. It is an international journal published in Spanish (print and online) and English (online), covering different fields of endocrinology and metabolism, including diabetes, obesity, and nutrition disorders, as well as the most relevant research produced mainly in Spanish language territories. The quality of the contents is ensured by a prestigious national and international board, and by a selected panel of specialists involved in a rigorous peer review. The result is that only manuscripts containing high quality research and with utmost interest for clinicians and professionals related in the field are published. The Journal publishes Original clinical and research articles, Reviews, Special articles, Clinical Guidelines, Position Statements from both societies and Letters to the editor. Endocrinología, Diabetes y Nutrición can be found at Science Citation Index Expanded, Medline/PubMed and SCOPUS.