Is continuous glucose monitoring during pregnancy beneficial on glycaemic control and infant birth weight in women with type 1 and type 2 diabetes?
- Murphy, H.R., Rayman, G., Lewis, K., Kelly, S., Johal, B., Duffield, K., Fowler, D., Campbell, P.J., Temple, R.C., 2008. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ 337, a1680–a1680.
- Continuous glycemic sensors were implanted by a nurse into the participants.
- At their scheduled clinic appointment the women handed their glucose monitor to the diabetes specialist nurse. Downloaded data was printed out before proceeding to identify periods of hypoglycaemia or hyperglycaemia.
- Participants were advised to note the likely causes for patterns that were out of range and to suggest solutions in terms of changes to diet, activity and insulin dose.
- Average birth weight for the intervention group was 3340g, compared to 3630g for group undergoing standard antenatal care.
- Macrosomia was recorded in 35% of the infants whose mothers were part of the study group, compared with 60% of those born under standard antenatal care.
- Infants classed as extremely large for gestational age were recorded in 14% of infants whose mother was in the intervention group, compared to 30% of those who received standard antenatal care.
- Yes (with confidence)
- Blood glucose targets were set for the women in the study at:
- 3.5-5.5 mmol/l before meals.
- <7.8 mmol/l one hour after meals.
- <6.7 mmol/l two hours after meals.
- Macrosomia, or high birth weight, remains the commonest complication of pregnancy in women with diabetes. Studies show the risk to be between 48.8% and 62.5% in women with diabetes.
- Macrosomia leads to complications in labour. For the infants there is a risk of intracranial haemorrhage, shoulder dystocia, neonatal hypoglycaemia, jaundice and respiratory distress.
- The consequences of birth weight are not limited to immediately apparent delivery injuries which can be prevented by caesarean section. Infants born large for gestational age have an increased risk of insulin resistance, obesity and type 2 diabetes.