Objective: The international consensus on continuous glucose monitoring (CGM) recommends time in range (TIR) target of >70% for pregnant people. Our aim was to compare outcomes between pregnant people with TIR ≤ versus >70%. Study design: Retrospective study of all people using CGM during pregnancy from January 2017 to May 2021 at a tertiary care center. All people with pregestational diabetes who used CGM and delivered at our center were included in the analysis. Primary neonatal outcome included any of the following: large for gestational age, NICU admission, need for intravenous glucose, or respiratory distress syndrome (RDS). Maternal outcomes included hypertensive disorders of pregnancy and delivery outcomes. Logistic regression was used to estimate unadjusted and adjusted odds ratios (aORs) with 95% Cis. Results: Of 78 people managed with CGM, 65 (80%) met inclusion criteria. While 33 people (50.1%) had TIR≤70%, 32 (49.2%) had TIR>70%. People with TIR≤70% were more likely to be younger, have a lower BMI, and have type 1 diabetes than those with TIR>70. After multivariable regression, there was no difference in the composite neonatal outcome between the groups (adjusted OR 0.56, 95% CI 0.16-1.92). However, neonates of people with TIR≤ 70% were more likely to be admitted to the NICU (p=0.035), to receive intravenous glucose (p=0.005), to have RDS (p=0.012), and had a longer hospital stay (p=0.012) compared to people with TIR>70%. Furthermore, people with TIR≤70% were more likely to develop hypertensive disorders (p=0.04) than those with TIR>70%. Conclusions: In this cohort, the target of TIR>70% was reached in about one out of 2 people with diabetes using CGM, which correlated with a reduction in neonatal and maternal complications.

OBJECTIVE: Preeclampsia (PreE) contributes to long-term maternal cardiovascular disease risk. By 2025, it is estimated that more women than men will have hypertension (HTN), yet the mechanisms contributing to the development of HTN in women are less understood. Anti-and pro-inflammatory T helper (Th) responses are dysregulated in PreE. A persistent imbalance of these Th responses following PreE may underlie the future development of HTN in women. Therefore, the objective of this study was to determine if the immune Th changes observed during PreE persist post-partum (PP). STUDY DESIGN: De-identified and coded plasma samples were obtained from the Magee-Women's Research Institute & Foundation or the University of Iowa Maternal-Fetal Tissue Bank (IRB 201808705) from women 1-3 (N¼93) or 8-10 (N¼58) years (yrs) following a normotensive or PreE-affected pregnancy. PP HTN was defined as having stage 1 or higher HTN as designated in the updated 2017 ACC/AHA guidelines. Th cytokine concentrations were determined via ELISAs and normalized to total protein. Average cytokine concentrations are reported in pg/g. RESULTS: Women with prior PreE had higher rates of HTN at 1-3 and 8-10 yrs PP (Table 1), compared to women with a normotensive pregnancy. At 1-3 yrs PP, concentrations of anti-inflammatory cytokines IL-4, IL-10, and TGFb were reduced in women with a prior PreE pregnancy. At 8-10 yrs PP, pro-inflammatory IL-6 and TNFa were significantly increased in women with prior PreE compared to women with a normotensive pregnancy (Table 2). CONCLUSION: Women with a prior PreE pregnancy had a higher incidence of HTN early (1-3 yrs) and late (8-10 yrs) PP compared to women with a normotensive pregnancy. Following PreE, anti-inflammatory Th cytokines continue to be suppressed in the early PP period, creating an inflammatory milieu. By 8-10 yrs PP, this inflammatory environment is further exacerbated by elevated levels of IL-6 and TNFa. This Th-associated inflammation is associated with increased rates of HTN and thus, may underlie the future development of HTN in women with a history of PreE.

Objective Continuous glucose monitoring (CGM) has become available for women with type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM) during pregnancy. The recommended time in range (TIR, blood glucose 70–140 mg/dL) and its correlation with adverse pregnancy outcomes in this group is unknown. Our aim was to compare maternal and neonatal outcomes in pregnant people with T2DM or GDM with average CGM TIR values >70 versus ≤ 70%. Study Design We conducted a retrospective cohort study of all individuals using CGM during pregnancy from January 2017 to June 2022. Individuals with type 1 diabetes mellitus, or those missing CGM or delivery data were excluded. Primary composite neonatal outcome included any of the following: large for gestational age, NICU admission, need for intravenous glucose, respiratory support, or neonatal death. Secondary outcomes included other maternal and neonatal outcomes. Regression models were used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI). Results During the study period, 141 individuals with diabetes utilized CGM during pregnancy, with 65 (46%) meeting inclusion criteria. Of the study population, 28 (43%) had TIR ≤70% and 37 (57%) had TIR > 70%. Compared with those with TIR > 70%, the primary composite outcome occurred more frequently in neonates of individuals TIR ≤70% (71.4 vs. 37.8%, aOR: 4.8, 95% CI: 1.6, 15.7). Furthermore, individuals with TIR ≤70% were more likely to have hypertensive disorders (42.9 vs. 16.2%, OR: 3.9, 95% CI: 1.3, 13.0), preterm delivery (54 vs. 27%, OR: 3.1, 95% CI: 1.1, 9.1), and cesarean delivery (96.4 vs. 51.4%, OR: 4.6, 95% CI: 2.2, 15.1) compared with those with TIR >70%. Conclusion Among people with T2DM or GDM who utilized CGM during pregnancy, 4 out 10 individuals had TIR ≤70% and, compared with those with TIR > 70%, they had a higher likelihood of adverse neonatal and maternal outcomes. Key Points