Time in Range and Pregnancy Outcomes in People with Diabetes Using Continuous Glucose Monitoring

Michal Fishel Bartal; Joycelyn A. Ashby Cornthwaite; Danna Ghafir; Clara Ward; Gladys Ortiz; Aleaha Louis; John Cornthwaite; Suneet S. P. Chauhan; Baha M. Sibai

doi:10.1055/a-1904-9279

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(05): 461-466
DOI: 10.1055/a-1904-9279

SMFM Fellowship Series Article

Time in Range and Pregnancy Outcomes in People with Diabetes Using Continuous Glucose Monitoring

Authors

Michal Fishel Bartal

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Joycelyn A. Ashby Cornthwaite

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Danna Ghafir

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Clara Ward

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Gladys Ortiz

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Aleaha Louis

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
John Cornthwaite

²Department of Earth, Environmental and Planetary Science, Rice University, Houston, Texas
Suneet S. P. Chauhan

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
Baha M. Sibai

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

Abstract

Objective The international consensus on continuous glucose monitoring (CGM) recommends time in range (TIR) target of >70% for pregnant people. Our aim was to compare outcomes between pregnant people with TIR ≤ versus >70%.

Study Design This study was a retrospective study of all people using CGM during pregnancy from January 2017 to May 2021 at a tertiary care center. All people with pregestational diabetes who used CGM and delivered at our center were included in the analysis. Primary neonatal outcome included any of the following: large for gestational age, neonatal intensive care unit (NICU) admission, need for intravenous (IV) glucose, or respiratory distress syndrome (RDS). Maternal outcomes included hypertensive disorders of pregnancy and delivery outcomes. Logistic regression was used to estimate unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results Of 78 people managed with CGM, 65 (80%) met inclusion criteria. While 33 people (50.1%) had TIR ≤70%, 32 (49.2%) had TIR >70%. People with TIR ≤70% were more likely to be younger, have a lower body mass index, and have type 1 diabetes than those with TIR >70%. After multivariable regression, there was no difference in the composite neonatal outcome between the groups (aOR: 0.56, 95% CI: 0.16–1.92). However, neonates of people with TIR ≤70% were more likely to be admitted to the NICU (p = 0.035), to receive IV glucose (p = 0.005), to have RDS (p = 0.012), and had a longer hospital stay (p = 0.012) compared with people with TIR >70%. Furthermore, people with TIR ≤70% were more likely to develop hypertensive disorders (p = 0.04) than those with TIR >70%.

Conclusion In this cohort, the target of TIR >70% was reached in about one out of two people with diabetes using CGM, which correlated with a reduction in neonatal and maternal complications.

Key Points

Among people with diabetes, 50% reached the recommended time in range using CGM.
Time in range >70% was associated with reducing the rate of some neonatal complications.
Time in range ≤70% was associated with increased risk for adverse maternal outcomes.

Keywords

neonatal morbidity - hypertensive disorder of pregnancy - continuous glucose monitoring - time in range

Full Text

References

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