Optimizing TIRp and Mean Glucose Levels in second trimester Reduces Fetal Risks in T1D Pregnancies: Study
Tight metabolic control during pregnancy, mainly keeping time in range during pregnancy (TIRp) and mean glucose levels within target ranges, may reduce the risk of large for gestational age (LGA) infants in women with Type 1 Diabetes (T1D). A recent study was conducted by Ana Maria and colleagues and was published in the journal Diabetes Research and Clinical Practice.
Through optimizing their blood glucose levels, pregnant women can significantly reduce risks for the fetus and the mother to suffer complications related to pregnancy. TIRp (63–140 mg/dL) and mean glucose thresholds that can contribute to better fetal outcomes in Latin American women with T1D were assessed in this study.
This was a prospective cohort study conducted on 62 pregnant women with T1D. All these women were on AID systems managing their glucose levels during pregnancy. The mean age of the patients was 31.9 years (±5.9), and their mean HbA1c was 7.57% (±1.29%). Establishing optimum TIRp and mean glucose cut-off points for predicting LGA with the Liu method in measurement at second-trimester, analyzing the strongest predictors of LGA. The analysis included comparisons of TIRp metrics, glucose levels, fetal outcomes, and the device types used, specifically examining outcomes with AHCL systems versus other AID systems.
LGA was higher among those with TIRp < 59.1% (50%) compared with those with TIRp > 59.1% (17.9%) (p = 0.010).
Hyperbilirubinemia was also more common in the former where TIRp < 59.1% (45%) in comparison to TIRp better the latter groups (11.8%) (p = 0.016).
The optimal TIRp cut-off point which identified as being able to reduce risk for LGA was > 59.1 % during the second trimester with a measure of sensitivity at 75% and specificity at 61% and an AUC of 0.68 (CI 0.48 – 0.88).
It reflected a reduced risk for LGA with sensitivity at 69%, specificity 70%, and an AUC at 0.70 (CI 0.51-0.88).
The third trimester was attained with improved metabolic control in women with AHCL devices compared to those on other devices of insulin delivery.
In conclusion, it is evident that keeping TIRp > 59.1% and mean glucose < 133 mg/dL during the second trimester confers reduced risks of LGA in the pregnancy outcomes of women with T1D. AHCL systems also support better metabolic control hence promising as a tool in the management of T1D pregnancies. Further research into the observed outcomes may validate the adoption of these metrics as the standard in handling these pregnancies.
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