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The Caribbean plate subducts beneath northwest South America at a shallow angle due to a large igneous province that added up to 12 km of buoyant crust. The overriding plate lacks volcanism and exhibits Laramide‐style uplifts over 500 km from the trench. Here, we illuminate the subduction structures through finite frequency teleseismic P‐wave tomography and connect those structures to the Laramide‐style deformation on the overriding plate. We use a new data set collected from the Caribbean‐Mérida Andes seismic experiment comprised of 65 temporary broadband stations integrated with permanent stations from the Colombian and Venezuelan national networks. We identify three segments of subducting Caribbean plate with one segment completely detached from the surface. The timing of the detachment aligns with other regional events, including the uplift of the Mérida Andes, about 10 Ma. Slab buoyancy post‐detachment likely resulted in recoupling with the overriding plate, reactivation of Jurassic‐aged rift structures and subsequent uplift of the Mérida Andes. Mantle counterflow over the broken segment induced by rollback of the attached slab likely contributed to the uplift of the Mérida Andes. We conclude that the northern limit of subduction lies south of the Oca‐Ancón fault, though the fault itself may be the surface expression of the boundary. The southern limit of subduction lies south of our study area.

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 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

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