Objective: Diabetic pregnancies carry a high risk for both mother and child, especially when glycemic control is poor. A novel technique that aims to improve glycemic control is the continuous glucose monitor (CGM). This tool is already in use to improve pregnancy outcome. This review presents the available evidence on the efficacy of CGM use in pregnancy and the effectiveness on pregnancy outcome.
Methods: A systematic search was conducted using PubMed, EMBASE, and the Cochrane Libraries for articles on CGM in pregnancy. We evaluated the selected articles with particular attention for clinical and cost-effectiveness of CGM to improve pregnancy outcome.
Results: We retrieved 5032 articles, 11 of which remained as relevant after selection according to predefined criteria. Most studies were limited to the evaluation of the role of CGM on clinical decision making. Only 2 studies were randomized controlled trials (RCTs) evaluating the effect on pregnancy outcome. One small RCT on retrospective CGM showed a significant reduction in third-trimester HbA1c and a significant reduction in neonatal macrosomia. A second RCT on real-time CGM did not show any effect on either glycemic control or on pregnancy outcome.
Conclusions: Current evidence on the efficacy of CGM on improving glycemic control during pregnancy as well as on the effectiveness on pregnancy outcome is limited to 2 RCTs with contradicting results. Evidence on the cost-effectiveness is lacking. Further proper RCTs on the effectiveness and cost-effectiveness of CGM in pregnancy are required before wide implementation in practice.
Target Audience: Obstetricians and gynecologists, family physicians and internists
Learning Objectives: After completing this CME activity, physicians should be better able to compare the results of the 2 major trials on the efficacy and effectiveness of the continuous glucose monitoring system (CGM) in treating pregnant women with diabetes and evaluate the evidence on the cost-effectiveness of CGMS use in pregnant women with diabetes.
*Doctor, Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Heidelberglaan, Utrecht, the Netherlands; †Doctor, Department of Internal Medicine/Endocrinology, Academic Medical Centre Amsterdam, Amsterdam-Zuidoost, the Netherlands; ‡Doctor, Department of Obstetrics and Gynaecology, Meander Medical Centre Amersfoort, Amersfoort, the Netherlands; §Professor, Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam-Zuidoost, the Netherlands; ∥Professor, Obstetrics and Gynaecology, University Medical Centre Utrecht, Heidelberglaan, Utrecht, the Netherlands
All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.
Correspondence requests to: Daphne N. Voormolen, MD, UMC Utrecht, the Netherlands. E-mail: email@example.com.