Experiences of Continuous Subcutaneous Insulin Infusion in Pregnant Women with Type 1 Diabetes During Delivery from Four Italian Centers: A Retrospective Observational Study

Fresa, R.; Visalli, N; Blasi, V. Di; Cavallaro, V; Ansaldi, E; Trifoglio, Oria; Abbruzzese, Santina; Bongiovanni, Marzia; Agrusta, M; Napoli, Angela

doi:10.1089/dia.2012.0260

Cited by 36 publications

(29 citation statements)

References 34 publications

(29 reference statements)

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“…HbA 1c in late pregnancy was comparable between women with and without infants with neonatal hypoglycaemia, despite its well‐known association to macrosomia . The prevalence of preterm delivery was generally low in this cohort and the numbers too few to evaluate this aspect in relationship to neonatal hypoglycaemia; however, preterm delivery is a well‐known risk factor of neonatal hypoglycaemia .…”

Section: Discussionmentioning

confidence: 68%

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Real‐time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes — observations from a randomized controlled trial

et al. 2013

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Section: Discussionmentioning

confidence: 68%

“…In the present study, we describe a protocol on subcutaneous insulin administration during labour and delivery with resulting median self‐monitored plasma glucose values within target range and relatively rare maternal hypoglycaemia . This finding adds to the debate on the mode of insulin delivery during labour and delivery .…”

Section: Discussionmentioning

confidence: 86%

Real‐time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes — observations from a randomized controlled trial

et al. 2013

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“…Both groups had stable peripartum glycemic values, but mean capillary blood glucose levels were significantly lower in the rtCGM group throughout labor compared with CSII alone. 42 Petrovski et al randomized 25 women with T1D using CSII therapy to constant or intermittent rtCGM use throughout gestation. A1C levels improved in both groups throughout pregnancy, but were significantly lower in early gestation in the constant CGM group.…”

Section: Sensor-augmented Pump Therapy In Pregnancymentioning

confidence: 99%

CGM, Pregnancy, and Remote Monitoring

Polsky

Garcetti

2017

Diabetes Technology & Therapeutics

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The glycemic goals of pregnancy are very narrow to reduce excess risks for numerous maternal and fetal complications. Continuous glucose monitors (CGMs) may help women achieve glucose goals and reduce hypoglycemia. CGM use has been found to be safe and effective in pregnancies associated with diabetes. CGM use can accurately identify glycemic patterns among women with and without diabetes in pregnancy. The data on the effects of CGM use on maternal and fetal outcomes are conflicting. Using CGMs in conjunction with continuous subcutaneous insulin infusion therapy in pregnancies complicated by diabetes may improve outcomes. There are limitations of CGM use that affect patients in and outside of pregnancy, as well as specific barriers that only affect pregnant women. Of importance, CGM use does not replace standard clinical care, but may be used an adjunctive tool in pregnancy. CGM remote monitoring in pregnancy is an understudied field. In this study, we review the studies on CGM use in pregnancy.

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“…However, this has not been studied in detail yet. 12,13 Neonatal hypoglycaemia is not clearly defined in the literature, with values defining it ranging from 1.6-2.2 mmol/L to 2.5-2.6 mmol/L. 14 In our group hospital policy defines it as <2.6 mmol/L.…”

Section: Discussionmentioning

confidence: 92%

The feasibility and impact of implementing NICE guidance on diabetes control during delivery

et al. 2017

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Aims: The aim of this study was to report on the practicality, feasibility and impact of implementing the National Institute for Health and Care Excellence (NICE) guidelines for the control of diabetes in women during labour and birth. Methods: We analysed case records of pregnant women with diabetes who delivered in the period between July 2014 and June 2015. The data were collected in relation to the availability of a plan in the notes, capillary blood glucose (CBG) monitoring, use of variable rate intravenous insulin infusion (VRIII), maintenance of CBG targets within 4-7 mmol/L, maternal hypoglycaemia during labour and neonatal hypoglycaemia. Results: Fifty-one women with diabetes delivered during this period. Only 45% of women were monitored by complete hourly CBGs until delivery. 27.4% of women had CBG ≥7 mmol/L but only 17.6% were started on VRIII. The VRIII group had a 22.2% incidence of minor maternal hypoglycaemia. Neonatal hypoglycaemia occurred in 47% of the babies. Conclusion: A CBG target of 4-7 mmol/L during labour and initiation of VRIII when levels are above this target in pregnant women with diabetes is difficult to achieve and is associated with some maternal hypoglycaemia. Repeat CBG measurements within half an hour and strict adherence to clear guidelines and protocols supported by more education and adequate staffing may improve results.Br J Diabetes 2017;17:ONLINE AHEAD OF PUBLICATION

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Experiences of Continuous Subcutaneous Insulin Infusion in Pregnant Women with Type 1 Diabetes During Delivery from Four Italian Centers: A Retrospective Observational Study

Abstract: CSII is possible and safe in different types of delivery in selected and educated women. RT-CGM helps to obtain better outcomes in terms of maternal peripartum CBG level.

Cited by 36 publications

References 34 publications

Real‐time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes — observations from a randomized controlled trial

Real‐time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes — observations from a randomized controlled trial

CGM, Pregnancy, and Remote Monitoring

The feasibility and impact of implementing NICE guidance on diabetes control during delivery

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