Background: Maternal glucose and weight gain are related to neonatal outcome in women with gestational diabetes mellitus (GDM). The aim of this study was to explore the influence of average third-trimester HbA1c and excess gestational weight gain on GDM neonatal complications. Materials and Methods: This observational study included 2037 Spanish singleton pregnant women with GDM followed in our Diabetes and Pregnancy Unit. The maternal HbA1c level was measured monthly from GDM diagnosis to delivery. Women were compared by average HbA1c level and weight gain categorized into ≤ or > the current Institute of Medicine (IOM) recommendations for body mass index. The differential effects of these factors on large-for-gestational-age birth weight and a composite of neonatal complications were assessed. Results: Women with an average third-trimester HbA1c ≥5.0% ( n = 1319) gave birth to 7.3% versus 3.8% ( p = 0.005) of large-for-gestational-age neonates and 22.0% versus 16.0% ( p = 0.006) of neonates with complications. Women with excess gestational weight gain ( n = 299) delivered 12.5% versus 5.2% ( p < 0.001) of large-for-gestational-age neonates and 24.7% versus 19.0% ( p = 0.022) of neonates with complications. In an adjusted multiple logistic regression analysis among mothers exposed to the respective risk factors, ∼47% and 52% of large-for-gestational-age neonates and 32% and 37% of neonatal complications were potentially preventable by attaining an average third-trimester HbA1c level <5.0% and optimizing gestational weight gain. Conclusions: Average third-trimester HbA1c level ≥5% and gestational weight gain above the IOM recommendation are relevant risk factors for neonatal complications in mothers with gestational diabetes.

Aims: To compare glycemic control and maternal–fetal outcomes of women with type 1 diabetes (T1D) using hybrid closed loop (HCL) vs. multiple daily insulin injections (MDI) plus continuous glucose monitoring (CGM). Methods: Multicenter prospective cohort study of pregnant women with T1D in Spain. We evaluated HbA1c and time spent within (TIR), below (TBR) and above (TAR) the pregnancy-specific glucose range 3.5–7.8 mmol/L. Adjusted models were performed for adverse pregnancy outcomes including baseline maternal characteristics and center. Results: 112 women were included (HCL n=59). Women in the HCL group had a longer duration of diabetes and higher rates of prepregnancy care. There were no between-group differences in HbA1c in any trimester. However, in the second trimester, MDI users had a greater decrease in HbA1c (-6.12±9.06 vs. -2.16 ±7.42 mmol/mol, p=0.031). No differences in TIR (3.5-7.8 mmol/L) and TAR were observed between HCL and MDI users, but with a higher total insulin dose in the second trimester (+0.13 IU/Kg/d). HCL therapy was associated with increased maternal weight gain during pregnancy (βadjusted 3.20 kg, 95%CI 0.90-5.50). Regarding neonatal outcomes, newborns of HCL users were more likely to have higher birthweight (βadjusted 279.0 g, 95% CI 39.5-518.5) and macrosomia (ORadjusted 3.18, 95% CI 1.05-9.67) compared to MDI users. These associations disappeared when maternal weight gain or third trimester HbA1c were included in the models. Conclusions: In a real-world setting, HCL users gained more weight during pregnancy and had larger newborns than MDI users, while achieving similar glycemic control in terms of HbA1c and TIR.

BACKGROUND: The aim of this study was to evaluate the impact on glycemic control during lockdown due to the COVID-19 pandemic in adults with type 1 diabetes (T1D). MATERIAL AND METHODS: Continuous glucose monitoring (CGM) metrics were obtained from adults with T1D and compared during three periods: before lockdown (Period 1), lockdown (Period 2) and de-escalation after the end of lockdown (Period 3). In addition, patients who presented clinically meaningful glycemic improvement during Period 2 (defined by a glucose management indicator [GMI] reduction ≥ 0.5%) were compared with those who did not present it, and a logistic regression analysis was used to select predictive variables. RESULTS: The study included 138 subjects. During Period 2, there was a decrease in mean glucose, GMI, time above range and an increase in time in range, compared with Period 1. During Period 3 these findings were maintained, in addition to a reduction in glycemic variability and an increase in sensor use and scans per day. Twenty-four patients (17.4%) presented clinically meaningful glycemic improvement during lockdown. No differences were detected between patients, except for the last laboratory A1c value. In the logistic regression analysis, continuous subcutaneous insulin infusion (CSII) therapy and last laboratory A1c increased the probability of glycemic improvement, while duration of diabetes decreased that probability. CONCLUSIONS: Most adults with T1D using CGM improved their glycemic control during the COVID-19 pandemic, not only during lockdown but also after it ended. A shorter duration of diabetes, CSII therapy and a higher last laboratory A1c value predicted glycemic improvement during lockdown.