Diabetes, Pregnancy: New Monitor
Continuous Sugar Monitoring Strongly Reduces Risk of Macrosomia
Macrosomia means big baby, but not in a healthy way. Macrosomia babies, defined as weighing in the 90th percentile or heavier, increase the risk in the mother for perineal lacerations and complicated labor. For the babies, there is increased risk of bleeding around the brain (intracranial hemorrhage), difficulty exiting the birth canal (shoulder dystocia), and respiratory distress. Generally, a diabetic mother’s risk for having a macrosomic baby is about 50/50.
While major improvements in diabetes care in pregnancy over the past years have reduced stillbirths and perinatal mortality, there has not been much impact on macrosomia. British researchers knew that achieving targeted average blood glucose (sugar), A1c around 7, did not help. They felt that better control of glucose after eating, which didn’t show up on average glucose measurements, was the key. They also felt that control in middle or late pregnancy was the most important time.
The Study
They invited women into their study, and divided them into a control group and an experimental group. Both groups were urged to monitor their blood glucose using finger stick samples seven to ten times a day, and adjust their medications and diet accordingly.
The experimental group also had an electronic monitor to sample blood sugar continuously for a week. It was used about once a month between gestation weeks eight and 32. The sensor, a tiny electrode, was inserted under the skin in the upper outer buttock.
The women could not see the readings of the monitor. At their next usual clinic visit, the monitor was downloaded, and the results shown to each woman. Patterns of high glucose, presumably after eating, showed up as spikes on the chart. Discussion was led by trained nurses, and centered around diet and exercise.
Outcomes
(1) Women who used the continuous glucose monitor had lower average blood sugars.
(2) The risk of macrosomia was reduced by almost half in the monitored women: 35% of the monitored women and 60% of the control women had macrosomic babies.
Comments
Reviewing results from the monitor apparently helped the women understand the effects of eating behavior--it was educational.
The glucose monitor under the skin was not microscopic, and might seem clumsy. The number of subjects was small. But if this study is validated in larger studies, and the electronics are made truly miniature, pregnant diabetic women in the future may have monitors inserted routinely.
One wonders if the future monitor might scream “Too much sugar!” immediately after eating an off-diet treat. That in itself might be a negative incentive to improve diet adherence.
Regardless, the study emphasizes the need pregnant women with diabetes to avoid sugar spikes, especially in the latter two trimesters.
Source: British Medical Journal, 25 September 2008, 337:a1680
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