Benefits of Real-Time Continuous Glucose Monitoring in Pregnancy

Yamamoto, Jennifer M.; Murphy, Helen

doi:10.1089/dia.2020.0667

Cited by 35 publications

(28 citation statements)

References 34 publications

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“…However, decreasing blood glucose values with insulin is associated with a high risk of maternal hypoglycemia, including severe episodes ( 87 ). Continuous glucose monitoring during pregnancy improves maternal glycemia and pregnancy outcomes, and is now recommended in pregnant women with type 1 diabetes ( 88 ). Moreover, it has been suggested that closed-loop and sensor-augmented pump insulin delivery could be efficient to lower blood glucose levels without increasing the risk of severe hypoglycemia in pregnant women ( 89 ).…”

Section: In Several Areas There Could Be Opportunities To Improve The...mentioning

confidence: 99%

Pregnancy in Women With Monogenic Diabetes due to Pathogenic Variants of the Glucokinase Gene: Lessons and Challenges

et al. 2022

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Heterozygous loss-of-function variants of the glucokinase (GCK) gene are responsible for a subtype of maturity-onset diabetes of the young (MODY). GCK-MODY is characterized by a mild hyperglycemia, mainly due to a higher blood glucose threshold for insulin secretion, and an up-regulated glucose counterregulation. GCK-MODY patients are asymptomatic, are not exposed to diabetes long-term complications, and do not require treatment. The diagnosis of GCK-MODY is made on the discovery of hyperglycemia by systematic screening, or by family screening. The situation is peculiar in GCK-MODY women during pregnancy for three reasons: 1. the degree of maternal hyperglycemia is sufficient to induce pregnancy adverse outcomes, as in pregestational or gestational diabetes; 2. the probability that a fetus inherits the maternal mutation is 50% and; 3. fetal insulin secretion is a major stimulus of fetal growth. Consequently, when the fetus has not inherited the maternal mutation, maternal hyperglycemia will trigger increased fetal insulin secretion and growth, with a high risk of macrosomia. By contrast, when the fetus has inherited the maternal mutation, its insulin secretion is set at the same threshold as the mother’s, and no fetal growth excess will occur. Thus, treatment of maternal hyperglycemia is necessary only in the former situation, and will lead to a risk of fetal growth restriction in the latter. It has been recommended that the management of diabetes in GCK-MODY pregnant women should be guided by assessment of fetal growth by serial ultrasounds, and institution of insulin therapy when the abdominal circumference is ≥ 75th percentile, considered as a surrogate for the fetal genotype. This strategy has not been validated in women with in GCK-MODY. Recently, the feasibility of non-invasive fetal genotyping has been demonstrated, that will improve the care of these women. Several challenges persist, including the identification of women with GCK-MODY before or early in pregnancy, and the modalities of insulin therapy. Yet, retrospective observational studies have shown that fetal genotype, not maternal treatment with insulin, is the main determinant of fetal growth and of the risk of macrosomia. Thus, further studies are needed to specify the management of GCK-MODY pregnant women during pregnancy.

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Section: In Several Areas There Could Be Opportunities To Improve The...mentioning

confidence: 99%

Pregnancy in Women With Monogenic Diabetes due to Pathogenic Variants of the Glucokinase Gene: Lessons and Challenges

et al. 2022

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“…For pregnant women with type 1 diabetes, uptake of CGM technology improves neonatal outcomes, 38 but CGM remains to be widely tested for pregnant individuals with type 2 diabetes. In the future, HbA 1c may become redundant with increasing use of CGM in pregnancy 39 . It is possible that gestational weight gain, as opposed to weight assessed at a single time point, such as at delivery in the current study, could affect the association between HbA 1c and perinatal outcomes.…”

Section: Discussionmentioning

confidence: 93%

Association of change in haemoglobin A1c with adverse perinatal outcomes in women with pregestational diabetes

et al. 2022

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Aims: To determine whether a net decline in glycosylated haemoglobin (HbA 1c ) from early to late pregnancy is associated with lower risk of adverse perinatal outcomes at delivery among women with pregestational diabetes. Methods:A retrospective analysis from 2012 to 2016 at a tertiary care centre. The exposure was the net change in HbA 1c from early (<20 weeks gestation) to late pregnancy (≥20 weeks gestation). Primary outcomes were large for gestational age (LGA) and neonatal hypoglycaemia. The association between outcomes per 6 mmol/mol (0.5%) absolute decrease in HbA 1c was evaluated using modified Poisson regression, and adjusted for age, body mass index, White Class, early HbA 1c and haemoglobin and gestational age at HbA 1c measurement and delivery.Results: Among 347 women with pregestational diabetes, HbA 1c was assessed in early (9 weeks [IQR 7,13]) and late pregnancy (31 weeks [IQR 29,34]). Mean HbA 1c decreased from early (59 mmol/mol [7.5%]) to late (47 mmol/mol [6.5%]) pregnancy. Each 6 mmol/mol (0.5%) absolute decrease in HbA 1c was associated with a 12% reduced risk of LGA infant (30%, aRR:0.88; 95% CI:0.81,0.95), and a 7% reduced risk of neonatal hypoglycaemia (35%, aRR:0.93; 95% CI:0.87,0.99). Preterm birth (36%, aRR:0.93; 95% CI:0.89,0.98) and neonatal intensive care unit admission (55%, aRR:0.95; 95% CI:0.91,0.98) decreased with a net decline in HbA 1c , but not caesarean delivery, pre-eclampsia, shoulder dystocia and respiratory distress syndrome. Conclusions:Women with pregestational diabetes with a reduction in HbA 1c may have fewer infants born LGA or with neonatal hypoglycaemia. Repeated assessment of HbA 1c may provide an additional measure of glycaemic control.

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“…The culmination of this evidence has resulted in the recommendation to offer isCGM to all pregnant women with PGDM who are unable or unwilling to use rtCGM ( 76 ).…”

Section: Technologiesmentioning

confidence: 99%

Glycaemic control and novel technology management strategies in pregestational diabetes mellitus

2023

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IntroductionPregestational diabetes (PGDM) is an increasingly common and complex condition that infers risk to both mother and infant. To prevent serious morbidity, strict glycaemic control is essential. The aim of this review is to review the glucose sensing and insulin delivering technologies currently available for women with PGDM.MethodsWe reviewed online databases for articles relating to technology use in pregnancy using a combination of keywords and MeSH headings. Relevant articles are included below.ResultsA number of technological advancements have improved care and outcomes for women with PGDM. Real time continuous glucose monitoring (rtCGM) offers clear advantages in terms of infants size and neonatal intensive care unit admissions; and further benefits are seen when combined with continuous subcutaneous insulin delivery (insulin pump) and algorithms which continuously adjust insulin levels to glucose targets (hybrid closed loop). Other advancements including flash or intermittent scanning CGM (isCGM) and stand-alone insulin pumps do not confer as many advantages for women and their infants, however they are increasingly used outside of pregnancy and many women enter pregnancy already using these devices.DiscussionThis article offers a discussion of the most commonly used technologies in pregnancy and evaluates their current and future roles.

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Benefits of Real-Time Continuous Glucose Monitoring in Pregnancy

Cited by 35 publications

References 34 publications

Pregnancy in Women With Monogenic Diabetes due to Pathogenic Variants of the Glucokinase Gene: Lessons and Challenges

Pregnancy in Women With Monogenic Diabetes due to Pathogenic Variants of the Glucokinase Gene: Lessons and Challenges

Association of change in haemoglobin A1c with adverse perinatal outcomes in women with pregestational diabetes

Glycaemic control and novel technology management strategies in pregestational diabetes mellitus

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