Patients with pregestational diabetes may benefit from use of a continuous subcutaneous insulin infusion pump paired with a continuous glucose monitor (CGM). Use of the tools has been associated with a reduction in maternal and neonatal morbidity, a recent study found.
"We were seeing an unacceptable burden of both maternal and fetal disease in our diabetic population," said Neil Hamill, MD, a maternal-fetal medicine specialist at Methodist Women's Hospital in Omaha, Nebraska, and an author of the study. "We thought the success with this technology in the nonpregnant population would and should translate into the pregnant population."
Hamill and his colleagues analyzed data from 55 pregnant patients who received care at the Women's Hospital Perinatal Center at the Nebraska Methodist Health System between October 2019 and October 2022. Everyone in the cohort had pregestational diabetes and required insulin prior to week 20 of pregnancy. They used CGMs for more than 2 weeks. The study set blood glucose levels of less than 140 mg/dL as a healthy benchmark.
Participants who had severe preeclampsia, who had delivered preterm, who had delivered a neonate with respiratory distress syndrome, and/or who had given birth to la arger-than-expected infant spent less time in the safe zone ― having a blood glucose level below 140 mg/dL ― than women who did not have those risk factors.
"When blood sugar control is better, maternal and fetal outcomes are improved," Hamill said.
Neetu Sodhi, MD, an ob/gyn at Providence Cedars-Sinai Tarzana Medical Center in Los Angeles, expressed optimism that use of blood glucose monitors and insulin pumps can improve outcomes for pregnant patients with pregestational diabetes.
"This is just another case for why it's so important for patients to have access to these types of devices that really, really improve their outcomes and their health, and now it's proven in the case of pregnancy outcomes too, or at least suggest strongly with this data," Sodhi said.
Mark Ebell, MD, a professor of epidemiology at the University of Georgia in Athens, was more skeptical, pointing out that study participants might have used other methods in addition to the technology to lower their blood sugar levels.
The findings suggest that insulin pumps are more manageable than multiple, daily self-injections. About 1 in 9 women have diabetes in the United States, and 35% of people newly diagnosed with the condition are women of reproductive age.
Hamill said that in future research, use of a stricter criterion for baseline blood sugar levels (<140 mg/dL) would be helpful, as would exploring how much time patients need to spend below that level for optimal outcomes.
"Those questions are really absent in the literature," Hamill said. "Most of our obstetrical literature is comparing treatment types. All those things are secondary. It's the blood sugar that confers the risk, and if we get the blood sugar better, risk is reduced."
Hamill added that the benefits of these technologies for patients with gestational diabetes are unclear in consideration of the limited duration of the disease and the time required to implant or install a monitor and pump, as well as associated risks and the cost of the devices.
Sodhi said clinicians who see patients during family planning visits should review morbidities and medical problems related to diabetes.
"I think this is a study that's maybe too early," Sodhi said. "They did 'guesstimates' on what the target blood glucose ranges to be looking at, but I think over time, we might, with more studies like this, be building a case to try to put these types of monitors in for patients who are young for the purpose of optimizing pregnancy outcomes."
The authors have disclosed no relevant financial relationships.
J Matern Fetal Neonatal Med. Published online July 19, 2023. Full text
Robert Fulton is a journalist living in California.
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Cite this: Continuous Glucose Monitors for Pregnant Patients? - Medscape - Aug 24, 2023.