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The impact of continuous glucose monitoring in women with diabetes in pregnancy on perinatal outcomes: A systematic review (#52)

Jessica Burk 1 , Glynis Ross 1 2 , Teri Hernandez 3 4 5 , Stephen Colagiuri 1 , Arianne Sweeting 1 2 6
  1. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  2. Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  3. College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
  4. Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
  5. Children’s Hospital Colorado, Aurora, CO, USA
  6. Sydney Institute for Women, Children and their Families, Sydney, NSW, Australia

Background:

Diabetes in Pregnancy (DIP), encompassing gestational diabetes (GDM), type 1 diabetes (T1D) and type 2 diabetes (T2D), affects >50 000 Australian women annually [1]. DIP is associated with greater risk of perinatal complications, corresponding to the severity of maternal hyperglycaemia [2, 3]. Self-monitoring of blood glucose (SMBG) currently represents standard care across DIP [4], while continuous glucose monitoring (CGM) is now recommended during pregnancy for women with T1D [4]. Evaluation of evidence reporting on the association between CGM glucose metrics and perinatal complications across the spectrum of DIP is needed. More broadly, the association between CGM and maternal and neonatal outcomes, and the relationship between specific glucose metrics and risk of perinatal complications across the spectrum of DIP is warranted to guide clinical practice. 

Aim:

To evaluate the impact of CGM on maternal and neonatal outcomes in DIP.

Method:

Systematic search of Medline, Embase, CENTRAL, CINAHL and Scopus from 2003 to 2023. Randomised controlled trials and prospective observational trials examining the relationship between CGM and maternal and neonatal outcomes in women with diabetes in pregnancy (T1D, T2D, and/or GDM) were included.

Main outcome measures:

Maternal:

Glycaemic markers: HbA1c, glycaemic variability parameters (i.e. glycaemic variability [GV], mean amplitude of glycaemic excursion [MAGE] and time in range [TIR]).

Pregnancy outcomes: gestational weight gain, hypertensive disorders in pregnancy, obstetric intervention, preterm delivery.

Neonatal: birthweight, large-for-gestational age, small-for-gestational age, macrosomia, respiratory distress, hypoglycaemia, hyperbilirubinaemia, congenital malformations, stillbirth, neonatal death.

Results:

A total of 4,016 titles and abstracts were screened. Among the 234 eligible for full text review, 22 have been included for data extraction. In T1D pregnancy, the CONCEPTT study [5] demonstrated clinical benefits and cost savings with CGM plus SMBG versus SMBG alone. Studies to date in T2D and GDM have not yet shown the same benefits from CGM. There are limited studies assessing the role of CGM in other forms of DIP such as maturity-onset diabetes of the young (MODY). 

Conclusions:

There is a lack of data supporting the current consensus recommendations for CGM metrics, specifically for GDM and T2D in pregnancy [6]. More studies are needed to assess the role of CGM in predicting perinatal complications, and the utility of specific glucose metrics, across the spectrum of DIP.

  1. AIHW. Diabetes [Web article]. 2023 [Available from: https://www.aihw.gov.au/reports/diabetes/diabetes]
  2. Sweeting A, Wong J, Murphy HR, Ross GP. A Clinical Update on Gestational Diabetes Mellitus. Endocrine reviews. 2022;43(5):763-93.
  3. Murphy HR, Howgate C, O'Keefe J, Myers J, Morgan M, Coleman MA, et al. Characteristics and outcomes of pregnant women with type 1 or type 2 diabetes: a 5-year national population-based cohort study. Lancet Diabetes Endocrinol. 2021;9(3):153-64.
  4. Rudland VL, Price SAL, Hughes R, Barrett HL, Lagstrom J, Porter C, et al. ADIPS 2020 guideline for pre-existing diabetes and pregnancy. Aust N Z J Obstet Gynaecol. 2020;60(6):E18-E52.
  5. Feig DS, Asztalos E, Corcoy R, De Leiva A, Donovan L, Hod M, et al. CONCEPTT: Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial: A multi-center, multi-national, randomized controlled trial - Study protocol. BMC pregnancy and childbirth. 2016;16(1):167.
  6. Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes care. 2019;42(8):1593-603.
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