Monitoring motherhood: Monitoring and optimizing glycaemia in women with pre-existing diabetes in pregnancy

Abstract

Despite recent advances in care, women with diabetes in pregnancy are still at increased risk of multiple pregnancy complications. Offspring exposed to hyperglycaemia in utero also experience long-term health sequelae affecting neurocognitive and cardiometabolic status. Many of these adverse consequences can be prevented or ameliorated with good medical care, specifically to optimise glycaemic control. The accurate assessment of glycaemia in pregnancy is therefore vital to safeguard the health of mother and child. However, there is no consensus about the best method of monitoring glycaemic control in pregnancy. Short-term changes in insulin dosage and lifestyle, with altered appetite, insulin sensitivity and red cell turnover create difficulties in interpretation of standard laboratory measures such as HbA1c. The ideal marker would provide short-term feedback on daily or weekly glycaemic control, with additional capability to predict pregnancies at high risk of suboptimal outcomes. Several novel biochemical markers are available which allow assessment of dynamic changes in glycaemia over weeks rather than months. Continuous glucose monitoring devices have advanced in accuracy and provide new opportunities for robust assessment of glycaemia in pregnancy. Recent work from the continuous glucose monitoring in pregnant women with type 1 diabetes trial (CONCEPTT) has provided information about the ability of different markers of glycaemia to predict pregnancy outcomes. The aim of this review is to summarise the care for women with pre-existing diabetes in pregnancy, and to highlight the important role of glycaemic monitoring in pregnancy.

A review of CONCEPTT study findings including subanalyses in pregnant women using continuous glucose monitoring with type 1 diabetes and their offspring

“…A continuous glucose monitor (CGM) is a sophisticated medical system that provides a continuous stream of glucose data, allowing individuals with diabetes to visualize their glucose levels in real-time and on demand. A CGM is a significant improvement over traditional self-monitoring blood glucose (SMBG) testing, which only provides a single glucose value at a given time, and has proven substantially better accuracy over standard glucometers ( 1 ). A CGM system consists of three parts: a sensor, a transmitter, and a monitoring device.…”

“…It will also notify the patient and the people the patient shares data with regarding hypoglycemia and hyperglycemia with alerts and alarms ( 3 , 4 ). Given the great advances in maternal care, most women can now expect to have a healthy and uncomplicated pregnancy, and deliver a healthy baby at the end of nine months ( 1 ). However, pregnancy still presents significant challenges, associated with maternal and fetal risk in women with preexisting T1D and T2D, and gestational diabetes.…”

Glycated albumin and continuous glucose monitoring metrics across pregnancy in women with pre‐gestational diabetes

“…Continuous glucose monitoring (CGM) enables users to monitor their glucose level, providing the opportunity to respond to glucose fluctuations as they occur 5 . With randomized controlled trials showing that CGM is associated with improvements in maternal glycaemic control and neonatal outcomes, 6 the use of CGM in antenatal care is increasing 7 . By recent international consensus for CGM monitoring, the pregnancy glucose target range for type 1 diabetes (T1D) was set to 63–140 mg/dl (3.5–7.8 mmol/L).…”

“…5 With randomized controlled trials showing that CGM is associated with improvements in maternal glycaemic control and neonatal outcomes, 6 the use of CGM in antenatal care is increasing. 7 By recent international consensus for CGM monitoring, the pregnancy glucose target range for type 1 diabetes (T1D) was set to 63-140 mg/dl (3.5-7.8 mmol/L). Women should strive to achieve >70% of time within target range.…”