Extrapolated Time in Range and Pregnancy Outcomes in Patients with Type 1 Diabetes

To assess the relationship between time in range (TIR), extrapolated from self-monitoring of blood glucose (SMBG) measures, and adverse perinatal outcomes in pregnant women with type 1 diabetes (T1D).

A retrospective cohort study was conducted, including singleton pregnancies that began antenatal care before 20 weeks of gestation and delivered live newborns without malformations between 2010 and 2019. Glycemic data from SMBG were categorized into TIR (63-140 mg/dL or 3.5-7.8 mmol/L), based on guidelines for real-time continuous glucose monitoring. Extrapolated TIR (eTIR) was defined as the proportion of time spent within the target range and categorized into three intervals: eTIR <50%, eTIR 50%-70%, and eTIR >70%. Clinical characteristics and obstetric outcomes were compared across these intervals. Multivariate logistic regression was used to evaluate the prediction of adverse outcomes, including preeclampsia, nephropathy, cesarean section, preterm birth, macrosomia, large for gestational age (LGA), small for gestational age (SGA), 5-minute Apgar score <7, shoulder dystocia, neonatal respiratory distress, neonatal hypoglycemia, and neonatal intensive care unit (NICU) admission.

Data from 140 pregnancies were analyzed. Of these, 20% had eTIR <50%, 53.6% had eTIR 50%-70%, and 26.4% had eTIR >70%. Women with eTIR 50%-70% and eTIR >70% were less likely to experience preterm birth (OR: 0.271; 95% CI: 0.094-0.786 and OR: 0.219; 95% CI: 0.058-0.826), neonatal respiratory distress (OR: 0.341; 95% CI: 0.124-0.936 and OR: 0.122; 95% CI: 0.029-0.516), and LGA infants (OR: 0.246; 95% CI: 0.084-0.719 and OR: 0.115; 95% CI: 0.028-0.469) compared with women with eTIR <50%.

Higher eTIR values were associated with a reduced risk of preterm birth, neonatal respiratory distress, and LGA infants. For pregnant women with T1D, achieving an eTIR above 50% was sufficient to decrease the risk of these adverse outcomes, highlighting the importance of glucose control even in challenging circumstances.