In exploratory analyses, we evaluated glycemic variability (GV) and gestational outcomes in pregnant women (n = 28) with type 1 diabetes (T1D). Gestational age at delivery was higher for women with lower glycemic measures, including estimated HbA1c (eHbA1c) (0.14% decrease in HbA1c per 1-week greater gestational age, P = 0.0035), mean sensor glucose (−3.9 mg/dL P = 0.0039), time spent >140 mg/dL (−3.1%, P = 0.0029), and higher time in range (TIR) of 63–140 mg/dL (3.2%, P = 0.0029). Third trimester measured HbA1c was significantly associated with gestational age at delivery (P = 0.0081). Preeclampsia was associated with less TIR in first (50.5% vs. 69.9%, P = 0.0034) and second trimesters (47.1% vs. 66.7%, P = 0.0025), but not with measured HbA1c. There were significant differences in other markers of GV (continuous overall net glycemic action, high blood glucose index, J-index, mean amplitude of glycemic excursions) with infant birth weight and gestational age at delivery. Thus, multiple markers of glycemia and GV were associated with gestational health outcomes in T1D pregnancies in this pilot study.
Clinical Trial Registration number: NCT02556554.
Get full access to this article
View all access options for this article.
References
1.
BattelinoT, DanneT, BergenstalRM, et al.: Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care, 2019; 42:1593–1603.
2.
BeyondACWG: Need for regulatory change to incorporate beyond A1C glycemic metrics. Diabetes Care, 2018; 41:e92–e94.
3.
BeckRW, ConnorCG, MullenDM, et al.: The fallacy of average: how using HbA1c alone to assess glycemic control can be misleading. Diabetes Care, 2017; 40:994–999.
4.
BeckRW, BergenstalRM, RiddlesworthTD, et al.: Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care, 2019; 42:400–405.
5.
GerbaudE, DarierR, MontaudonM, et al.: Glycemic variability is a powerful independent predictive factor of midterm major adverse cardiac events in patients with diabetes with acute coronary syndrome. Diabetes Care, 2019; 42:674–681.
6.
Smith-PalmerJ, BrandleM, TrevisanR, et al.: Assessment of the association between glycemic variability and diabetes-related complications in type 1 and type 2 diabetes. Diabetes Res Clin Pract, 2014; 105:273–284.
PolskyS, GiordanoD, VoelmleMK, et al.: Using technology to advance type 1 diabetes care among women during the reproductive years and in pregnancy. Postgrad Med, 2016; 128:418–426.
9.
MullaBM, NoorN, James-ToddT, et al.: Continuous glucose monitoring, glycemic variability, and excessive fetal growth in pregnancies complicated by type 1 diabetes. Diabetes Technol Ther, 2018; 20:413–419.
10.
KristensenK, OggeLE, SengpielV, et al.: Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies. Diabetologia, 2019; 62:1143–1153.
11.
PolskyS, GarcettiR, PyleL, et al.: Continuous glucose monitor use with and without remote monitoring in pregnant women with type 1 diabetes: a pilot study. PLoS One, 2020; 15:e0230476.
12.
PolskyS, GarcettiR, PyleL, et al.: Continuous glucose monitor use with remote monitoring reduces fear of hypoglycemia in pregnant women with type 1 diabetes: a pilot study. J Diabetes Sci Technol, 2020; 14:191–192.
13.
VigersT, ChanCL, Snell-BergeonJ, et al.: cgmanalysis: an R package for descriptive analysis of continuous glucose monitor data. PLoS One, 2019; 14:e0216851.
14.
FeigDS, DonovanLE, CorcoyR, et al.: Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet, 2017; 390:2347–2359.
15.
YamamotoJM, MurphyHR: Benefits of real-time continuous glucose monitoring in pregnancy. Diabetes Technol Ther, 2021; 23(S1):S8–S14.
16.
McGrathRT, GlastrasSJ, SeehoSK, et al.: Association between glycemic variability, HbA1c, and large-for-gestational-age neonates in women with type 1 diabetes. Diabetes Care, 2017; 40:e98–e100.
17.
MurphyHR, HowgateC, O'KeefeJ, et al.: Characteristics and outcomes of pregnant women with type 1 or type 2 diabetes: a 5-year national population-based cohort study. Lancet Diabetes Endocrinol, 2021; 9:153–164.
18.
ScottEM, FeigDS, MurphyHR, et al.: Continuous glucose monitoring in pregnancy: importance of analysing temporal profiles to understand clinical outcomes. Diabetes Care, 2020; 43:1178–1184.
19.
FeigDS, AsztalosE, CorcoyR, et al.: CONCEPTT: continuous glucose monitoring in women with type 1 diabetes in pregnancy trial: a multi-center, multi-national, randomized controlled trial—study protocol. BMC Pregnancy Childbirth, 2016; 16:167.
20.
LawGR, EllisonGT, SecherAL, et al.: Analysis of continuous glucose monitoring in pregnant women with diabetes: distinct temporal patterns of glucose associated with large-for-gestational-age infants. Diabetes Care, 2015; 38:1319–1325.
21.
GuptaR, KhouryJ, AltayeM, et al.: Glycemic excursions in type 1 diabetes in pregnancy: a semiparametric statistical approach to identify sensitive time points during gestation. J Diabetes Res, 2017; 2017:2852913.
22.
DalfraMG, SartoreG, Di CianniG, et al.: Glucose variability in diabetic pregnancy. Diabetes Technol Ther, 2011; 13:853–859.
23.
MeekCL, TundidorD, FeigDS, et al.: Novel biochemical markers of glycemia to predict pregnancy outcomes in women with type 1 diabetes. Diabetes Care, 2021; 44:681–689.
24.
CastorinoK, PolskyS, O'MalleyG, et al.: Performance of the Dexcom G6 continuous glucose monitoring system in pregnant women with diabetes. Diabetes Technol Ther, 2020; 22:943–947.
25.
NielsenLR, EkbomP, DammP, et al.: HbA1c levels are significantly lower in early and late pregnancy. Diabetes Care, 2004; 27:1200–1201.
26.
LawGR, GilthorpeMS, SecherAL, et al.: Translating HbA1c measurements into estimated average glucose values in pregnant women with diabetes. Diabetologia, 2017; 60:618–624.
27.
KerssenA, EversIM, de ValkHW, VisserGH: Poor glucose control in women with type 1 diabetes mellitus and ‘safe’ hemoglobin A1c values in the first trimester of pregnancy. J Matern Fetal Neonatal Med, 2003; 13:309–313.
28.
BeckRW, BergenstalRM, ChengP, et al.: The relationships between time in range, hyperglycemia metrics, and HbA1c. J Diabetes Sci Technol, 2019; 13:614–626.
29.
JensenDM, DammP, Moelsted-PedersenL, et al.: Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care, 2004; 27:2819–2823.
30.
ReeceEA, SivanE, FrancisG, et al.: Pregnancy outcomes among women with and without diabetic microvascular disease (White's classes B to FR) versus non-diabetic controls. Am J Perinatol, 1998; 15:549–555.
31.
VestgaardM, SommerMC, RingholmL, et al.: Prediction of preeclampsia in type 1 diabetes in early pregnancy by clinical predictors: a systematic review. J Matern Fetal Neonatal Med, 2018; 31:1933–1939.
