Managing Preexisting Diabetes for Pregnancy

Kitzmiller, John L.; Block, Jennifer M.; Brown, F. C.; Catalano, Patrick M.; Conway, Deborah L.; Coustan, Donald R.; Gunderson, Erica P.; Herman, William H.; Hoffman, Lisa; Inturrisi, Maribeth; Jovanovič, Lois; Kjos, S; Knopp, Robert H.; Montoro, Martin; Ogata, Edward S.; Paramsothy, Pathmaja; Reader, Diane; Rosenn, Barak; Thomas, Alyce M.; Kirkman, M. Sue

doi:10.2337/dc08-9020

Cited by 440 publications

(347 citation statements)

References 180 publications

(77 reference statements)

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“…Seven-point profiles and glucose log sheets are recommended for routine antenatal care in diabetic pregnancies. 2 In women on MDIs, CGM does not provide information on insulin doses or carbohydrates consumed such as is seen on glucose log sheets, making insulin adjustments challenging based on CGM data alone. CGM technology has improved drastically since its introduction.…”

Section: Caveats About Cgm Use In Pregnancymentioning

confidence: 99%

“…These risks include fetal loss, congenital anomalies, abnormal fetal size (large-for-gestational age [LGA]; small-for-gestational age; macrosomia), preeclampsia/eclampsia, cesarean section, neonatal hypoglycemia, and neonatal hyperbilirubinemia, among others. [1][2][3][4] Therefore, the American Diabetes Association (ADA) recommends tight glycemic control throughout gestation 5 (Table 1). One tool that may help achieve optimal glycemic control in pregnancy is the continuous glucose monitor (CGM).…”

mentioning

confidence: 99%

“…[6][7][8] The ADA recommends CGM use in pregnancy for some high-risk women, such as those with hypoglycemia unawareness. 2 This review aims to (1) highlight studies on CGM use in pregnancy regarding safety, glycemic parameters, and maternal and fetal outcomes and (2) discuss remote monitoring methods of sensor glucose data and limitations of the technology.…”

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confidence: 99%

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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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Section: Caveats About Cgm Use In Pregnancymentioning

confidence: 99%

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confidence: 99%

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CGM, Pregnancy, and Remote Monitoring

Polsky

Garcetti

2017

Diabetes Technology & Therapeutics

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“…Delivery of coordinated, effective programs is essential for women with diabetes in pregnancy. Whenever possible, care of pregnant women with diabetes should be given by a multidisciplinary patient-centred team [36]. Women with diabetes in pregnant are at risk of developing perinatal complications that require the development of multidisciplinary programs at centers of excellence that greatly reduce maternal, fetal, and neonatal complications [36].…”

Section:  Subsidization Of Costs Of Carementioning

confidence: 99%

Barriers and Facilitators of Adherence to Anti-Diabetic Therapy in Pregnant Women with Diabetes: Health Care Workers’ Perspectives

Mukona¹,

Munjanja²,

Zvinavashe³

et al. 2017

JDM

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Global prevalence of hyperglycaemia in pregnancy in women of 20 -49 years was estimated to be 16.9% and affecting 21.4 million live births, in 2013, 90% of which occurred in developing countries. The cornerstone of anti-diabetic therapy is diet, physical activity and medications. The study utilized a qualitative descriptive design using key informant interviews from August 2016 to November 2016 to explore challenges of adherence to anti-diabetic therapy in pregnant women with diabetes at a central hospital in Harare, Zimbabwe. Permission to conduct the study was obtained from the respective local and national ethical review boards. All participants gave verbal and written informed consent. A sample of eight key informants directly involved in the care of pregnant women with diabetes was purposively selected for key informant interviews. Key informants should have worked with diabetic pregnant women for at least one year. Sample size was determined by data saturation. Interviews followed a semi structured questionnaire that had sections on the burden of diabetes in pregnancy, challenges of adherence, challenges in management and possible solutions to challenges faced. All interviews were conducted in a private room. Detailed notes were taken during the interviews which were also being audiotaped. Trustworthiness was achieved by observing credibility, dependability, transferability and confirmability. Thematic analysis was done. Thematic analysis was done manually. The stages of data analysis followed were data organization, familiarization, transcription, coding, developing a thematic framework, indexing, displaying and reporting. Major themes identified were barriers and facilitators of adherence to anti-diabetic therapy. Categories under barriers were financial barriers, lack of health edu- 161cation, lack of trained personnel, shortage of staff and lack of collaboration among practitioners. Categories under facilitators of adherence were subsidization of care, formal training of professionals, promoting collaboration and establishment of a unit dedicated to the care of pregnant women with diabetes. Barriers and solutions identified should be utilized to develop frameworks to promote adherence to anti-diabetic therapy incidence of adverse perinatal outcomes.

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“…Maternal factors known to influence pregnancy outcomes in type 1 diabetes include glycaemic control and blood pressure levels during pregnancy as well as underlying diabetic vascular complications [3].…”

Section: Introductionmentioning

confidence: 99%

White’s classification and pregnancy outcome in women with type 1 diabetes: a population-based cohort study

et al. 2015

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Aims/hypothesis Our aim was to examine the association of White's classification with obstetric and perinatal risk factors and outcomes in type 1 diabetic patients. Methods Obstetric records of a population-based cohort of 1,094 consecutive type 1 diabetic patients with a singleton childbirth during 1988-2011 were studied. The most recent childbirth of each woman was included. Results The prepregnancy and the first trimester HbA 1c increased from White's class B to F (p for trend <0.001). Systolic and diastolic blood pressure and pre-eclampsia frequencies increased stepwise from class B to F (p for trends <0.001).Vaginal deliveries decreased and Caesarean sections and deliveries before 37 weeks increased from class B to F (p for trends <0.001). Fetal macrosomia (p for trend=0.003) decreased and small-for-gestational age infants (p for trend=0.002) and neonatal intensive care unit admissions (p for trend=0.001) increased from class B to F. In logistic regression analysis, White's classes were associated with pre-eclampsia but, with the exception of class R (proliferative retinopathy) and F (nephropathy), not with other adverse outcomes when adjusted for first trimester HbA 1c ≥7% (≥53 mmol/mol) and blood pressure ≥140/90 mmHg. First trimester HbA 1c ≥7% was associated with pre-eclampsia, preterm delivery, fetal macrosomia and neonatal intensive care unit admission. Conclusions/interpretation White's classification is useful in estimating the risk of pre-eclampsia in early pregnancy independently of suboptimal glycaemic control and hypertension. However, its utility in predicting adverse perinatal outcomes seems limited when information on first trimester HbA 1c , blood pressure and diabetic microvascular complications is available.

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Managing Preexisting Diabetes for Pregnancy

Cited by 440 publications

References 180 publications

CGM, Pregnancy, and Remote Monitoring

CGM, Pregnancy, and Remote Monitoring

Barriers and Facilitators of Adherence to Anti-Diabetic Therapy in Pregnant Women with Diabetes: Health Care Workers’ Perspectives

White’s classification and pregnancy outcome in women with type 1 diabetes: a population-based cohort study

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