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

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.

Performance of the Dexcom G6 Continuous Glucose Monitoring System in Pregnant Women with Diabetes

“… 24 , 36 The CGM may also be beneficial in women with other types of diabetes. A systematic review by Yu et al 37 reported that CGM was superior to SMBG in women with GDM for detecting hypoglycemic and hyperglycemic excursions, which may result in improved maternal and fetal outcomes for CGM users with GDM.…”

Evaluation of Glycaemic Control, Glucose Variability and Hypoglycaemia on Long-Term Continuous Subcutaneous Infusion vs. Multiple Daily Injections: Observational Study in Pregnancies With Pre-Existing Type 1 Diabetes

“…Concerning pregnancy outcomes, we could not demonstrate that CSII treatment induced a lower incidence of adverse pregnancy events compared with MDI therapy. The studies in this field gave conflicting results and, despite some positive results, most of the studies reported [32,33].…”

A Systematic Review of Collective Evidences Investigating the Effect of Diabetes Monitoring Systems and Their Application in Health Care

“…Jones et al, reported that CGM is able to reduce neonatal hypoglycemia (RR 0·66, 95% CI 0·48 to 0·93; 3 studies, 428 infants) ( 21 ). Latest updated evidence from 2019 by Yu et al suggests that CGM is superior to SMBG among pregnant women with gestational diabetes mellitus as it is able to detect hypoglycemic and hyperglycemic episodes ( 36 ). Therefore, regular monitoring of glucose levels in pregnant women with diabetes through specific glucose monitoring devices could ensure limitation of hypoglycemic episodes and then influence the outcomes for both mother and child.…”