In Pregnant Women with T1D, Higher Time-in-Range Improves Maternal, Neonatal Outcomes: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in the American Journal of Obstetrics and Gynecology that examined the association between perinatal outcomes and time-in-range as assessed by continuous glucose monitors (CGMs) used in pregnant women with type 1 diabetes (T1D).

The study

Researchers conducted a multicenter retrospective cohort study with data from 91 pregnant women with T1D using CGMs who delivered from 2020 to 2022 at 5 University of California Fetal Consortium sites.

All women had a CGM target range of 70 mg/dL to 140 mg/dL. Researchers recorded time in range at 12, 16, 20, 24, 28 and 32 weeks.

The primary maternal outcome was preeclampsia, and the primary neonatal outcome was larger than gestational age (LGA).

Mean age of the participants was 32.6 years. Approximately two-thirds (67%) identified as non-Hispanic White and 14% as Hispanic. The median periconception HbA1c was 6.7% (range 5.8 – 7.6%). In the cohort, 81% of women used an insulin pump and 72% did not have diabetes-related microvascular disease. Median time since T1D diagnosis was 16 years.

The findings

Researchers found that at as early as 12 weeks gestation, every 5-unit increase in TIR was associated with a 45% reduced risk for preeclampsia (adjusted RR = 0.55; 95% CI, 0.3-0.99) and with a 46% reduced risk for LGA infants (aRR = 0.54; 95% CI, 0.29-0.99) in adjusted analyses.

Authors' comment

"These findings can be used to counsel patients regarding the risk of pregnancy complications at specific time-in-range values, and to encourage patients that even small improvements in time-in-range can have significant impact on pregnancy outcomes. Larger studies are needed to further explore these findings and to identify optimal time-in-range to reduce perinatal complication rates."

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