{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:15:43Z","timestamp":1787019343300,"version":"build-2736575974"},"reference-count":25,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T00:00:00Z","timestamp":1729123200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Diabetes Sci Technol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The Glycemia Risk Index (GRI) describes the quality of glycemic control, emphasizing extreme hypoglycemia and hyperglycemia more than less extreme values. However, a pregnancy-specific GRI (pGRI), tailored to the tighter target glucose range required during pregnancy, has not been established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively evaluated clinical, metabolic, and Continuous Glucose Monitoring (CGM) data across pregnancy in women with insulin-treated diabetes, managed between September 2021 and March 2024 at the University Hospital of Pisa. First and second levels of hyperglycemia (TAR1: 140-180 mg\/dL, TAR2: &gt;180 mg\/dL) and hypoglycemia (TBR1: 63-54 mg\/dL, TBR2: &lt;54 mg\/dL) were used to calculate the pGRI at each trimester. Logistic regression analysis investigated the association between pGRI and risk of at least one adverse neonatal outcome (among preterm delivery, macrosomia, large for gestational age, small for gestational age, neonatal hypoglycemia, neonatal jaundice, and neonatal intensive care unit admission).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 45 pregnant women, 25 (56%) experienced at least one adverse neonatal outcome. In the third trimester, women with adverse outcomes had significantly higher total TAR (26 [12-32]% vs 10 [4-23]%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .018) and lower TIR (71 [64-83]% vs 88 [75-92]%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .007). Specifically, the difference was notable in TAR2 (6 [2-15]% vs 1 [0-4]%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .004), whereas TAR1 was comparable between the 2 groups. Accordingly, third trimester pGRI was higher in women with adverse neonatal outcomes (38 [18-49]% vs 18 [10-31]%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .013) and, at logistic regression, slightly but significantly increased the risk of adverse neonatal outcomes (1.044 [1.004-1.086],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .024).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Pregnant women with insulin-treated diabetes reporting adverse neonatal outcomes spent more time in hyperglycemia, particularly in extreme hyperglycemia. Therefore, the level of hyperglycemia should always be assessed during pregnancy. The pGRI, emphasizing extreme hyperglycemia, may be a novel comprehensive tool for assessing the risk of adverse neonatal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19322968241289957","type":"journal-article","created":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T14:22:59Z","timestamp":1729174979000},"page":"736-742","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Predicting the Risk of Adverse Neonatal Outcomes in Women With Insulin-Treated Diabetes: Is It Time for a Pregnancy-Specific Glycemic Risk Index?"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1673-2327","authenticated-orcid":false,"given":"Fabrizia","family":"Citro","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Hospital of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Belcari","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Galleano","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Venturi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorella","family":"Battini","sequence":"additional","affiliation":[{"name":"Maternal-Infant Department, University Hospital of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Marchetti","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Bertolotto","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Hospital of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Aragona","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Hospital of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,10,17]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707943"},{"key":"e_1_3_3_3_2","volume":"47","author":"15. Management of diabetes in pregnancy: standards of care in diabetes-2024","year":"2024","unstructured":"15. Management of diabetes in pregnancy: standards of care in diabetes-2024. Diabetes Care. 2024;47(suppl 1):S282-S294.","journal-title":"Diabetes Care"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32400-5"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.2174\/1573399818666220422083935"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.2337\/dci19-0028"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2303911"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc23-0173"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(24)00089-5"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/19322968221085273"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2017.0416"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2023.101488"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2023.0264"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-023-03511-7"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15068"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2023.0165"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2023.0040"},{"key":"e_1_3_3_18_2","unstructured":"Glycemia risk index calculator. https:\/\/www.diabetestechnology.org\/gri\/. Accessed October 12 2024."},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60932-6"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2016.08.003"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11476-0"},{"key":"e_1_3_3_22_2","first-page":"100823","article-title":"Continuous glucose monitoring-derived glycemic metrics and adverse pregnancy outcomes among women with gestational diabetes: a prospective cohort study","volume":"39","author":"Liang X","year":"2023","unstructured":"Liang X, Fu Y, Lu S, et al. Continuous glucose monitoring-derived glycemic metrics and adverse pregnancy outcomes among women with gestational diabetes: a prospective cohort study. Lancet Reg Health West Pac. 2023;39:100823.","journal-title":"Lancet Reg Health West Pac"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2021.0194"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2023.0300"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-0500"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2023.0133"}],"container-title":["Journal of Diabetes Science and Technology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19322968241289957","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19322968241289957","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19322968241289957","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T09:47:51Z","timestamp":1782294471000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19322968241289957"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,17]]},"references-count":25,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/19322968241289957"],"URL":"https:\/\/doi.org\/10.1177\/19322968241289957","relation":{},"ISSN":["1932-2968","1932-2968"],"issn-type":[{"value":"1932-2968","type":"print"},{"value":"1932-2968","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,17]]}}}