Association of continuous glucose monitoring indicators during pregnancy and antepartum glucose with the risk of neonatal hypoglycemia in women with type 1 diabetes mellitus.

Objective To investigate the association between continuous glucose monitoring (CGM) during pregnancy and antepartum glucose with the risk of neonatal hypoglycemia in women with type 1 diabetes mellitus (T1DM). Methods This study was a multicenter, prospective, observational cohort study. Pregnant women with T1DM from 11 hospitals nationwide were enrolled from January 2015 to December 2017. CGM was used for glycemic control in pregnancy. Antepartum 2-hour capillary blood glucose and neonatal outcomes were recorded. A total of 73 women who used CGM during pregnancy were included in the study and divided into the neonatal hypoglycemia group (14 cases) and the neonatal normoglycemia group (59 cases) based on neonatal capillary glucose (neonatal hypoglycemia defined as<2.2 mmol/L) after delivery. Data on maternal glycated hemoglobin A1c (HbA1c), CGM metrics [mean blood glucose, time in range (TIR), time above range (TAR1>7.8 mmol/L, TAR2>13.9 mmol/L), time below range (TBR), standard deviation of blood glucose (SDBG), mean amplitude of glucose excursions (MAGE), coefficient of variation (CV)] during pregnancy, antepartum 2-hour blood glucose levels, gestational age at delivery, and neonatal obstetric outcomes [birth weight, birth length, premature delivery, neonatal intensive care unit (NICU) admission] were compared between groups. Comparisons between groups were made using the two independent samples t test, rank sum test, χ² test and Fisher exact test. The influencing factors of neonatal hypoglycemia were analyzed by multivariate logistic regression models. Results Compared with neonatal normoglycemia group, women in the neonatal hypoglycemia group had higher mean blood glucose [(6.91±0.71) vs. (6.38±0.81) mmol/L, t=2.041, P<0.05], TAR2 [0.81% (0, 4.36%) vs. 0 (0, 0.64%), Z=2.064, P<0.05], and MAGE [(6.42±3.24) vs. (4.60±1.67) mmol/L, t=2.137, P<0.05] in the first trimester (P<0.05). Antepartum 2-hour blood glucose was higher in the neonatal hypoglycemia group [(7.75±2.22) vs. (6.13±2.10) mmol/L, t=2.324, P<0.05]. The incidences of preterm birth [35.71% (5/14) vs. 11.86% (7/59), χ2=4.686, P< 0.05] and NICU admission [71.43% (10/14) vs. 32.20% (19/59), χ2=5.725, P<0.05] were higher in the neonatal hypoglycemia group than in the neonatal normoglycemia group (P<0.05). The multivariate logistic regression analysis revealed that antepartum 2-hour blood glucose was the independent influencing factor of neonatal hypoglycemia (OR=2.23, 95%CI 1.09-4.54, P<0.05). Conclusions Increased mean blood glucose, TAR, and MAGE in the first trimester were associated with a higher risk of neonatal hypoglycemia in pregnant women with T1DM. Antepartum 2-hour blood glucose was independently associated with the risk of neonatal hypoglycemia. [ABSTRACT FROM AUTHOR]