文献类型：期刊文献

英文题名：The combined impact of time in range and HOMA-IR on neonatal outcomes in gestational diabetes mellitus: A retrospective cohort study

作者：Chen, Mali;Sun, Jun[1];Yang, Jing[2];Wang, Jianfen[2];Shu, Chengzhao[2];Zhang, Lili[2];Chai, Xiaoli[1,3];Dong, Yan[1,2]

第一作者：Sun, Jun;Chen, Mali

通信作者：Dong, Y[1]

机构：[1]Gansu Prov Cent Hosp, Gansu Prov Matern & Child Care Hosp, Dept Obstet, Lanzhou, Gansu, Peoples R China;[2]Gansu Univ Chinese Med, Clin Med Coll 1, 143 Qilihebei St, Lanzhou 730000, Gansu, Peoples R China;[3]Pingliang Matern & Child Care Hosp, Dept Obstet, Lanzhou, Gansu, Peoples R China

第一机构：Gansu Prov Cent Hosp, Gansu Prov Matern & Child Care Hosp, Dept Obstet, Lanzhou, Gansu, Peoples R China

通信机构：[1]corresponding author), Gansu Univ Chinese Med, Clin Med Coll 1, 143 Qilihebei St, Lanzhou 730000, Gansu, Peoples R China.|[10735]甘肃中医药大学;

年份：2026

卷号：105

期号：11

起止页码：e48074

外文期刊名：MEDICINE

收录：;Scopus(收录号：2-s2.0-105033429052);WOS:【SCI-EXPANDED(收录号:WOS:001715447300001)】；

基金：This research was funded by the Natural Science Foundation of Gansu Province (No. 2022JR5RA724).

语种：英文

外文关键词：gestational diabetes mellitus; HOMA-IR; insulin resistance; neonatal outcomes; time in range

摘要：Time in range (TIR) derived from continuous glucose monitoring and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) are independent predictors of maternal and neonatal outcomes in gestational diabetes mellitus (GDM). However, their combined effect on neonatal outcomes remains unclear. This study aimed to investigate the joint influence of TIR and HOMA-IR on neonatal outcomes in GDM patients. In this retrospective cohort study, 166 women with GDM were categorized into 4 groups based on TIR levels (cutoff: 90%) and HOMA-IR (cutoff: cohort median): Group A (high-TIR/low-IR), Group B (high-TIR/high-IR), Group C (low-TIR/low-IR), and Group D (low-TIR/high-IR). HOMA-IR was calculated at "24 to 28 weeks' gestation" gestation using fasting plasma glucose and insulin levels obtained during the oral glucose tolerance test. Neonatal complications, including hypoglycemia, macrosomia, and hyperbilirubinemia, were compared across groups. Compared with Group A (high-TIR/low-IR), Group D (low-TIR/high-IR) demonstrated the highest risk for adverse neonatal outcomes, with significantly higher incidence of neonatal hypoglycemia (OR: 4.52, 95% CI: 1.89-10.78) and macrosomia (OR: 3.45, 95% CI: 1.45-8.19), along with higher mean neonatal bilirubin levels (10.97 +/- 1.72 mg/dL vs 8.99 +/- 2.09 mg/dL, P < .001). Poor glycemic control (low TIR) combined with significant insulin resistance (high HOMA-IR) identifies a subgroup of GDM patients at the highest risk for adverse neonatal outcomes. The joint assessment of TIR and HOMA-IR may facilitate precise risk stratification and personalized management in clinical practice.