Application and Utility of Continuous Glucose Monitoring in Pregnancy: A Systematic Review

Qi Yu; Izzuddin M Aris; Kok Hian Tan; Ling-Jun Li

doi:10.3389/fendo.2019.00697

Application and Utility of Continuous Glucose Monitoring in Pregnancy: A Systematic Review

Front Endocrinol (Lausanne). 2019 Oct 11:10:697. doi: 10.3389/fendo.2019.00697. eCollection 2019.

Authors

Qi Yu¹, Izzuddin M Aris², Kok Hian Tan^{3

4}, Ling-Jun Li^{3

4}

Affiliations

¹ Duke Medical School, Duke University, Durham, NC, United States.
² Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States.
³ Division of O&G, KK Women's and Children's Hospital, Singapore, Singapore.
⁴ OBGYN ACP, Duke-NUS Medical School, Singapore, Singapore.

Abstract

Background: In the past decade, continuous glucose monitoring (CGM) has been proven to have similar accuracy to self-monitoring of blood glucose (SMBG) and yet provides better therapy optimization and detects trends in glucose values due to higher frequency of testing. Even though the feasibility and utility of CGM has been proven successfully in Type 1 and 2 diabetes, there is a lack of knowledge of its application and effectiveness in pregnancy, especially in gestational diabetes mellitus (GDM). In this review, we aimed to summarize and evaluate the updated scientific evidence on the application of CGM in pregnancies complicated with GDM. Methods: A search using keywords related to CGM and GDM on PubMed was conducted and articles were filtered based on full text, year of publication (Jan 1998-Dec 2018), human subject studies, and written in English. Reviews and duplicate articles were removed. A final total of 29 articles were included in this review. Results: In terms of maternal and fetal outcomes, inconsistent evidence was reported. Among GDM patients using CGM and SMBG, two randomized controlled trials (RCTs) found no significant differences in macrosomia, birth weight (BW), and gestational age (GA) at delivery between these two groups, while one prospective cohort found a lower incidence of cesarean section and macrosomia in CGM use subjects. Furthermore, CGM use was consistently found to have increased detection in dysglycemia and glycemic variability compared to SMBG. In terms of clinical utility, CGM use led to more treatment adjustments and lower gestational weight gain (GWG). Lastly, CGM use showed higher postprandial glucose levels in GDM-complicated pregnancies than in normal pregnancies. Conclusion: Current updated evidence suggests that CGM is superior to SMBG among GDM pregnancies in terms of detecting hypoglycemic and hyperglycemic episodes, which might result in an improvement of maternal and fetal outcomes. In addition, CGM detects a wider glycemic variability in GDM mothers than non-GDM controls. Further research with larger sample sizes and complete pregnancy coverage is needed to explore the clinical utility such as screening and predictive values of CGM for GDM.

Keywords: continuous glucose monitoring; gestational diabetes; literature review; maternal and fetal outcomes; self-monitoring of blood glucose.

Publication types

Systematic Review