Continuous Glucose Monitoring During Pregnancy May Improve Outcomes

A new study published in BMJ 2008; 337:a1680 demonstrates that more data collected through use of CGM, creates better blood sugar control throughout the entire pregnancy.

“Continuous glucose monitoring during pregnancy is associated with improved glycaemic control in the third trimester, lower birth weight, and reduced risk of macrosomia,” the study authors write. “If confirmed by other studies these data have important implications for the antenatal management of women with diabetes as well as the immediate and longer term health of their infants.”

Macrosomia, defined as infant birth weight on or above the 90th centile for sex and gestational age, remains the commonest complication of pregnancy in women with diabetes. Women with both type 1 and type 2 are at risk for macrosomic babies. This risk leads to complications during birth and often emergency c-sections. There are also risks for the babies such as respiratory distress, shoulder dyscotia which basically means that the shoulders get stuck during delivery, anfd long term risks such as obesity and type 2 diagnosis.

“Major advances in the management of diabetes during pregnancy over the past 50 years have contributed to dramatic reductions in stillbirths and perinatal mortality but have not had a major impact on birth weight, with the risk of macrosomia persistently increased.”

I think this is so interesting because I remember my blood sugar management becoming much more challenging in the last trimester with my two pregnancies. My insulin resistance was such that I was giving nearly three times as much insulin in the last trimester and gaining more weight than before without really changing my diet or exercise. It was very frustrating. And with both boys I had to have c-sections, my first delievery was an emergency c-section and my second was planned but both boys-even with tight control-were big babies. Will was 8lbs. 10 oz. and Miles was 10lbs. 8 oz!

“Novel methods of continuous glucose monitoring provide up to 288 measurements a day. Detailed data on the magnitude and duration of glucose fluctuations, particularly overnight and after meals, give unique insights into daily glycaemic control, which are especially valuable during the physiological changes of pregnancy. Additionally, continuous glucose monitoring provides patients with visual feedback on the consequences onglycaemia of factors such as diet, exercise, and insulin regimens, which can be harnessed as a powerful educational tool.”

The women in the study, between the ages of 16-45, type 1 and type 2, were followed by a team of doctors who reviewed the CGM readings at each appointment, advising the women about diet, exercise and insulin dose. A1C levels were measured every four weeks. The control group used standard blood sugar testing. Differences between the two groups began to emerge at 28-32 weeks gestation. 

“We have shown that supplementary continuous glucose monitoring provided in a routine clinical setting leads to better glycaemic control and reduced risk of macrosomia. If confirmed by other studies these data have important implications for the antenatal management of women with diabetes as well as the immediate and longer term health of their infants.”

This study is important for many reasons, and will hopefully encourage insurance companies to cover the cost of the expensive CGM equipment for diabetic women wanting to become pregnant. This study can provide hope for a decrese in costly c-sections as well as lifelong health issues such as obesity and type 2 diabetes.

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