The World Health Organisation projects that the number of diabetes-related deaths will double between the years 2005 and 2030. An important method for reducing the number of new cases of diabetes is by screening for and controlling glucose in women with gestational diabetes, the form of diabetes that afflicts up to 10% of the pregnant population. Uncontrolled gestational diabetes mellitus results in an increased risk of complications due to maternal hyperglycaemia and the resultant fetal hyperinsulinaemia. These complications include macrosomia and an increased risk of metabolic disorders including diabetes later in the child’s life.
Advances in the treatment of gestational diabetes have shown promising results in minimising fetal complications; they have also helped to slow the vicious cycle of women who contract gestational diabetes mellitus producing children with a high risk of developing diabetes later in life.
A comprehensive literature review with an emphasis on technology has resulted in the following collection of papers relating to pregnancy and diabetes. Last year there were several technological advances in glucose monitoring. This year the applications of telemedicine in the treatment of gestational diabetes and the use of ultrasound for early detection of the disease have been at the forefront.
The authors aimed to include articles that were not only relevant to the field of diabetes technology in pregnancy, but that also improved treatment and advanced understanding. The study design and results were also carefully examined in considering the articles. The selected articles contain findings that provide new techniques for diagnosing gestational diabetes mellitus as well as provide additional treatment methods for those affected by the disease.
Reduced incidence of gestational diabetes with bariatric surgery
A. E. Burke,1W. L. Bennett,2R. M. Jamshidi,1M. M. Gilson,3J. M. Clark2,5, J. B. Segal,2A. D. Shore,4T. H. Magnuson,3F. Dominici,6A. W. Wu,2,3,5M. A. Makary3
1Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA,2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA,3Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA,4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, and6Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
J Am Coll Surg 2010; 3: 1–7
Background: Bariatric surgery used today for overweight patients allows for significant weight loss. Obesity during pregnancy is known to increase the risk of many complications, including diabetes. This study is designed to show any association between bariatric surgery and the incidence of gestational diabetes mellitus (GDM), including its related complications.
Methods: A retrospective study was performed comparing rates of GDM and related outcomes (caesarean section, large-for-gestational-age infant, shoulder dystocia, and infection) between a group of women who delivered before having bariatric surgery and a group who delivered after. Data were collected from a private insurance claims database on 23,594 women who had bariatric surgery between 2002 and 2006.
Results: There were 354 women who had bariatric surgery before pregnancy, and 346 women who had bariatric surgery after giving birth. Women who had bariatric surgery before giving birth had lower incidences of GDM [8% vs. 27%, odds ratio (OR) 0.23, 95% confidence interval (CI) 0.15–0.36] and caesarean section (28% vs. 43%, OR 0.53, 95% CI 0.39–0.72) than women who had the surgery after giving birth.
Conclusions: Bariatric surgery before pregnancy is associated with a decreased incidence of GDM and caesarean section in following pregnancies. Bariatric surgery should be considered for obese women of childbearing age.
- • Comment: Bariatric surgery is known to cause significant weight loss and reduce symptoms of obesity, including incidences of diabetes. This study extends the knowledge of the benefits of bariatric surgery to include a reduction of the risk of developing gestational diabetes. The large sample size (700 women) helps to validate this paper’s claims. It appears evident that obese women should consider bariatric surgery before pregnancy.
Continuous subcutaneous insulin infusion versus multiple daily injections
Continuous subcutaneous insulin infusion versus multiple daily injections in pregnant women with type 1 diabetes
S. Gonzalez-Romero,1,2I. Gonzalez-Molero,1M. Fernandez-Abellan,3M. E. Dominguez-Lopez,1S. Ruiz-de-Adana,1,2G. Olveira,1,2F. Soriguer1,2
1Endocrinology and Nutrition Department, Hospital Regional Universitario Carlos Haya, Malaga, Spain,2CIBER de Diabetes y Enfermedades Metabolicas Asociadas, Barcelona, Spain, and3Obstetrics and Gynecology Department, Hospital Regional Universitario Carlos Haya, Malaga, Spain
Diabetes Technol Ther 2010; 12: 263–9
Background: Continuous subcutaneous insulin infusion (CSII) is an alternative treatment to multiple daily injections (MDI) for people with type 1 diabetes mellitus. However, no clear difference has been established for treatment in pregnant women with type 1 diabetes. This study aims to compare the effects of CSII vs. MDI on metabolic control and obstetric and perinatal outcome of pregnancies in women with type 1 diabetes.
Methods: Thirty-five pregnant women were treated with CSII and 64 pregnant women were treated with MDI. Metabolic control and obstetric and perinatal outcome of the pregnancies were analysed.
Results: Women in both groups lowered their glycosylated haemoglobin (A1c) during pregnancy and there was no significant difference in metabolic control or obstetric and perinatal outcome.
Conclusions: CSII is a safe and valid treatment for women with type 1 diabetes during pregnancy. Thus far CSII has not been associated with any improved pregnancy outcome.
Continuous subcutaneous insulin infusion and multiple dose insulin injections in type 1 diabetic pregnant women: a case–control study
L. Volpe,1F. Pancani,1M. Aragona,1C. Lencioni,1L. Battini,2A. Ghio,1V. Resi,1A. Bertolotto,1S. del Prato,1G. Di Cianni1
1Department of Endocrinology and Metabolism, Section of Diabetes, University Hospital of Pisa, Pisa, Italy, and2Division of Gynaecology and Obstetrics, University Hospital of Pisa, Pisa, Italy
Gynecol Endocrinol 2010; 26: 193–6
Background: CSII is an alternative treatment to MDI for people with type 1 diabetes mellitus. No clear difference has been established for treatment in pregnant women with type 1 diabetes mellitus. This study aims to compare the effects of CSII vs. MDI on metabolic control and obstetric and perinatal outcome of pregnancies in women with type 1 diabetes.
Methods: This study uses retrospective analysis of 42 women with type 1 diabetes mellitus; 20 were treated with CSII and 22 with MDI. The outcomes considered include the mother’s weight gain, change in A1c, total daily insulin dose, episodes of severe hypoglycaemia, macrosomia, frequency of caesarean sections, pre-term deliveries, birth weight, retinopathy and nephropathy.
Results: In almost all of the considered outcomes there were no significant differences between patients receiving CSII or MDI. Insulin requirement was significantly lower (p = 0.009) in CSII than in MDI. In all, 45% vs. 22.7% had large-for-gestational-age infants with CSII vs. MDI.
Conclusions: CSII and MDI are both safe and valid treatments for women with type 1 diabetes mellitus during pregnancy.
Glycaemic control and selected pregnancy outcomes in type 1 diabetes women on continuous subcutaneous insulin infusion and multiple daily injections: the significance of pregnancy planning
K. Cyganek,1,2A. Hebda-Szydlo,1,2B. Katra,1,2J. Skupien,3T. Klupa,1,2I. Janas,1I. Kaim,2,4J. Sieradzki,1,2A. Reron,2,4M. I. Malecki1,2
1Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland,2University Hospital, Krakow, Poland,3Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA, USA, and4Department of Obstetrics and Perinatology, Jagiellonian University Medical College, Krakow, Poland
Diabetes Technol Ther 2010; 12: 41–7
Background: CSII and MDI are common methods to maintain glycaemic control in pregnant women with type 1 diabetes mellitus. The effect of pregnancy planning (treatment started before conception) on pregnancy outcome in women with type 1 diabetes was assessed, as well as the efficacy and safety of CSII and MDI during pregnancy.
Methods: A total of 269 pregnant women with type 1 diabetes mellitus were followed; 157 were treated with MDI, 42 with CSII, and 70 switched from MDI to CSII in the first trimester. Of the 269, 116 woman planned pregnancy: 58 in the MDI group, 38 in the CSII group, and 20 in the MDI/CSII group.
Results: The A1c in the first trimester differed significantly in women who had planned pregnancy and those who had not. In the second trimester A1c improved by 1.5% in the not-planning women and 0.9% in the planning women, although still lower overall in the planning group. In the third trimester women in the planned pregnancy group still had a lower overall A1c than the non-planned group. Women treated with CSII had a weight gain greater by 2 kg than those in the MDI group.
Conclusions: For women with type 1 diabetes mellitus, both CSII and MDI provide excellent glycaemic control although CSII seems to result in greater maternal weight gain. Additionally, planning the pregnancy improved glycaemic control.
- • Comments: Each of these papers makes the point that CSII for the treatment of diabetes during pregnancy is not inferior to MDI. While this is good news for those able to afford the convenience CSII has to offer, it also means that women with low incomes will not receive inferior treatment using MDI. In today’s economy MDI provides a lower cost alternative to CSII for the treatment of diabetes during pregnancy while maintaining similar glycaemic control. Planning pregnancies seems to provide further benefits and improved glycaemic control.
The outcomes of gestational diabetes mellitus after a telecare approach are not inferior to traditional outpatient clinic visits
N. Perez-Ferre, M. Galindo, M. D. Fernandez, V. Velasco, I. Runkle, M. J. de la Cruz, P. M. Rojas-Marcos, L. del Valle, A. L. Calle-Pascual
Endocrinology and Nutrition Department, Hospital Clinico Universitario San Carlos, Madrid, Spain
Int J Endocrinol 2010; 2010: 1–6
Background: Over the past decade there have been many advances in the field of telemedicine, which allow for more frequent and convenient interactions with healthcare providers. GDM is a condition best cared for through tight metabolic control and accurate patient monitoring. This study aims to evaluate the use of a telemedicine-based system using the internet and short message services to monitor women with GDM.
Methods: Ninety-seven women with GDM were studied; 48 women received traditional face-to-face visits and 49 women were placed in an intervention group with a telemedicine system for transmission of capillary glucose data and short text messages with weekly professional feedback.
Results: There was no significant difference between the two groups, despite a significant reduction in clinic visits in the experimental group, particularly in insulin-treated women. No significant differences were seen in A1c levels, normal vaginal deliveries and large-for-gestational-age newborns.
Conclusions: The telemedicine-based system achieved similar pregnancy, delivery and newborn outcomes compared with traditional treatment, significantly reducing the need for outpatient clinic visits.
The effect of telemedicine on outcome and quality of life in pregnant women with diabetes
M. G. Dalfra,1A. Nicolucci,2A. Lapolla1
1Dipartimento di Scienze Mediche e Chirurgiche, Universita di Padova, Italy, and2Farmacologia Epidemiologia, Consorzio Mario Negri Sud, S Maria Imbaro, Italy
J Telemed Telecare 2009; 15: 238–42
Background: Over the past decade there have been many advances in the field of telemedicine, which allow for more frequent and convenient interactions with healthcare providers. GDM is a condition best cared for through tight metabolic control and accurate patient monitoring. This study evaluates the effects of telemedicine on maternal and fetal outcome in women with diabetes.
Methods: A total of 276 pregnant women with diabetes were enrolled in the study and sequentially assigned to a telemedicine or a control group. The women in the telemedicine group submitted their glucose data every week by phone and had a medical examination at a diabetes clinic once a month. The women in the control group received a medical examination every two weeks. Questionnaires measuring depression, health-related quality of life, stress and distress for the impact of diabetes were used to assess the non-clinical variables of the treatment.
Results: Telemedicine provided better metabolic control in the third trimester in women with GDM and a lower rate of caesarean sections and macrosomia. Women in the telemedicine group also showed lower levels of frustration and concerns about their diabetes, and better acceptance of their diabetic condition.
Conclusions: Telemedicine provides a convenient method for monitoring women with diabetes during pregnancy. The outcomes of telemedicine are just as good and in many cases better than traditional methods.
A telemedicine system based on internet and short message service as a new approach in the follow-up of patients with gestational diabetes
N. Perez-Ferre, M. Galindo, M. D. Fernandez, V. Velasco, M. J. de la Cruz, P. Martin, L. del Valle, A. L. Calle-Pascual
Endocrinology and Nutrition Department, San Carlos University Hospital, Madrid, Spain
Diabetes Res Clin Pr 2010; 87: 15–17
Background: Over the past decade there have been many advances in the field of telemedicine, which allow for more frequent and convenient interactions with healthcare providers. GDM is a condition best cared for through tight metabolic control and accurate patient monitoring. This study aims to evaluate the feasibility of a telemedicine-based system using the internet and short message services to monitor women with GDM.
Methods: Ninety-seven women with GDM were studied; 48 women received traditional face-to-face visits and 49 women were placed in an intervention group with a telemedicine system for transmission of capillary glucose data and short text messages with weekly professional feedback.
Results: Compared to the control group, the telemedicine group reduced the number of unscheduled face-to-face visits by 62%, and by 82.7% in the subgroup of insulin-treated patients.
Conclusions: Telemedicine is a valid means of monitoring women with GDM; it decreases the number of visits to a physician while achieving similar pregnancy and perinatal outcomes as traditional treatment.
- • Comments: These three papers effectively address several aspects of implementing telemedicine for the treatment of diabetes during pregnancy. It appears that telemedicine’s use is not only feasible, but also capable of providing the same glycaemic control and perinatal outcome with fewer visits to a physician. While this appears beneficial from a patient standpoint, one must also consider the economic impact at the physician’s side. With fewer visits doctors would be making less money to provide the same care, not to mention the costs of creating a telemedicine system. If telemedicine in the treatment of diabetes during pregnancy proves to be mutually beneficial, it could drastically change current treatment methods.
Gestational diabetes mellitus screening based on the gene chip technique
Z. Liang,1M. Dong,2Q. Cheng,2D. Chen1
1Obstetric Department, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China, and2Central Laboratory, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
Diabetes Res Clin Pr 2010; 89: 167–73
Background: GDM is currently defined as diabetes first diagnosed during pregnancy, which often includes women with diabetes before pregnancy yet undiagnosed until pregnant. The standard method of diagnosing the disease is with an oral glucose tolerance test (GTT). This study looks at genetics using gene chip technology as the basis for diagnosing the risk of developing GDM.
Methods: Blood samples were collected from 50 women with GDM and 80 healthy pregnant women. DNA samples were sequenced and probed for single nucleotide polymorphisms (SNPs) known to be associated with diabetes.
Results: Four SNPs were identified to be significantly different between GDM and control patients. When the gene chip technique was used on a random cohort of pregnant women with and without GDM, the gene chip results were precisely matched by DNA sequencing.
Conclusions: The gene chip technique provides a viable option for diagnosing an increased risk of developing GDM.
- • Comment: Early detection and treatment for GDM have been shown to result in better glycaemic control during pregnancy, thereby improving perinatal outcome. Although expensive and difficult to perform at this point, the gene chip technique could significantly improve metabolic control in women with GDM given its capability of diagnosing GDM early in pregnancy. Standard glucose challenge tests are time consuming and may cause vomiting among other problems in some pregnant women, which would not be an issue using the gene chip technique.
Computerised analysis of fetal heart rate in pregnancies complicated by gestational diabetes mellitus, gestational hypertension, intrauterine growth restriction and premature rupture of membranes
G. Buscicchio, L. Gentilucci, A. L. Tranquilli
Institute for Maternal and Child Sciences, Marche Polytechnic University, Ancona, Italy
J Matern Fetal Neonatal Med 2010; 23: 335–7
Background: GDM complicates approximately 2%–5% of all pregnancies. The offspring of women with GDM are prone to adverse effects such as macrosomia and various types of birth trauma. This study sought to compare the fetal heart rate, as determined by computer analysis, in pregnancies complicated by GDM with the fetal heart rate in normal non-diabetic pregnancies.
Methods: The study consisted of large populations for comparison: 100 pregnant woman affected by GDM were treated with diet therapy, 100 pregnant woman affected by GDM were put on insulin therapy, 100 pregnant woman affected by pregnancy-induced hypertension, 100 pregnant women affected by intrauterine growth restriction, 100 with premature rupture of membranes far from term and 100 normal pregnancies. Computerised fetal heart rate monitoring was performed by computerised cardiotocography on all women for at least 30 min and the results were assessed using Dawes and Redman parameters.
Results: The duration of episodes of low fetal heart rate variation and short-term variation were significantly higher in pregnancies complicated by GDM.
Conclusions: Although these changes in fetal heart rate were only slight, they reflect fetal well-being. Computerised cardiotocography may be the only device capable of detecting these slight alterations.
- • Comment: This study shows further evidence for the rationale to treat GDM. It is an important finding because it shows that there are already complications in utero before the difficult delivery takes place. The episodes of low fetal heart rate variation and short-term variation represent a sign of fetal distress.
Increased oxidative modifications of amniotic fluid albumin in pregnancies associated with gestational diabetes mellitus
M. R. Boisvert,1K. G. Koski,2C. D. Skinner1
1Department of Chemistry and Biochemistry, Concordia University, Montreal, Quebec, Canada, and2School of Dietetics and Human Nutrition, McGill University (Macdonald Campus), Montreal, Canada
Anal Chem 2010; 82: 1133–7
Background: It is known that abnormal distributions of protein isoforms can be related to a variety of pathological states and have been used for the diagnosis or prognosis of several diseases. Human serum albumin (HSA) is the must abundant protein in amniotic fluid and can undergo several modifications in response to oxidative stress. This study seeks to explain how differences in oxidative modifications of HSA can be measured using mass spectrometry and used as a diagnostic tool for GDM.
Methods: Amniotic fluid samples were extracted from 26 GDM and 26 non-GDM women at 15 weeks’ gestation. HSA was extracted from the samples and oxidative modifications were analysed by mass spectrometry.
Results: The relative contribution of permanently oxidised HSA in women with GDM was greater (p = 0.002) than for non-GDM women, and reversibly oxidised HSA was lower (p = 0.006).
Conclusions: Mass spectrometry of amniotic HSA is a viable method for identifying women at risk for GDM. This study also implies that the progression towards GDM may be set prior to 15 weeks’ gestation.
- • Comment: Women not characterised as being at high risk for developing GDM usually do not have a diagnostic glucose challenge test until 24 weeks of gestation. While amniocentesis is a risky procedure, if a woman is having one performed for another purpose unrelated to diabetes screening, it would be worthwhile to have the HSA analysed, especially since the estimated cost is $8.00.
Sonographic assessment of fetal subcutaneous fat tissue thickness as an indicator of gestational diabetes
T. Tantanasis, A. Daniilidis, C. Giannoulis, M. Tzafettas, K. Dinas, A. Loufopoulos, K. Papathanasiou
Second University Department of Obstetrics and Gynecology, Hippokratio General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Eur J Obstet Gynecol Reprod Biol 2010; 152: 157–62
Background: Currently a GTT is the most frequently used diagnostic test for GDM. The GTT is a very time consuming process and is poorly tolerated among patients. This study aimed to use ultrasound to measure fetal subcutaneous fat in pregnancies with abnormal and normal GTTs as a means to diagnose gestational diabetes.
Methods: Thirty-five women with singleton pregnancies between 24 and 26 weeks’ gestation participated in the study. Using ultrasound, fetal subcutaneous fat thickness was measured in 20 women with abnormal GTTs and 15 women with normal GTTs. Fat thickness was measured at three different points on the fetal body: the biparietal diameter, the abdominal circumference and the thoracic spine. At least two measurements were taken for each parameter and the mean value was recorded.
Results: The values of the three variables in the abnormal group were higher at statistically significant values than the normal group.
Conclusions: This study suggests the possibility of using ultrasound to measure fetal subcutaneous fat measurements as an additional criterion to distinguish women at high risk for gestational diabetes. The screening method is non-invasive and cost effective.
- • Comment: This study confirms that ultrasound measurements of fetal body mass are a good indicator of gestational diabetes. Oral GTTs can be time consuming and uncomfortable for patients. Ultrasound represents a non-invasive and cost effective solution to this problem. Further studies need to be done with larger numbers of patients but this presents a nice basis for further research.
Sonographic prediction of fetal macrosomia: the consequences of false diagnosis
N. Melamed, Y. Yogev, I. Meizner, R. Mashiach, A. Ben-Haroush
Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
J Ultrasound Med 2010; 29: 225–30
Background: The prenatal sonographic diagnosis of macrosomia can often be imprecise and, unfortunately, false diagnosis is common. The prediction of macrosomia, whether it is accurate or inaccurate, has considerable effects on obstetrical management. The aim of this study was to assess the consequences of a false diagnosis on maternal and neonatal outcomes when the estimated fetal weight was below the threshold that mandated caesarean delivery in the Helen Schneider Hospital for Women.
Methods: This was a case–control study that assessed women (n = 1938) who underwent fetal weight estimation up to 3 days before delivery and delivered a neonate weighing between 3500 and 4499 g. The false-positive and false-negative groups were compared with the true-negative and true-positive groups, respectively and the results were analysed.
Results: The caesarean delivery rate was 2 to 2.5 times higher when estimated fetal weight was 4000–4499 g regardless of actual birth weight. Failure to detect macrosomia resulted in a higher rate of major perineal trauma, 5-min Apgar scores of less than 7, and neonatal trauma, mostly related to the higher rate of instrumental deliveries. The use of another sonographic model with a lower false-positive rate could lower the caesarean delivery rate by 5%.
Conclusions: False diagnosis of macrosomia leads to higher caesarean delivery rates and neonatal/maternal complications.
- • Comment: This study is a good reference for the consequences of a false diagnosis of macrosomia. Macrosomia is a harmful condition that can lead to neonatal and maternal complications. The diagnosis alone of macrosomia has been shown to increase the rate of caesarean delivery regardless of birth weight. This study shows the need for further studies to determine the optimal regression formula for predicting fetal macrosomia.
Improved ultrasonographic estimation of birth weight in macrosomic fetuses by application of a correction factor to the gestation-adjusted projection method
C. M. Zelig, S. H. Deering, P. G. Napolitano
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Madigan Army Medical Center, Tocoma, WA, USA
J Ultrasound Med 2009; 28: 1357–64
Background: In 1996, Mongelli and Gardosi (1) introduced the gestation-adjusted projection (GAP) method, which uses a single third-trimester ultrasonographic examination to predict birth weight. In two subsequent studies, the GAP method was shown to be a more accurate predictor of fetal weight than an ultrasonographic examination close to delivery. The positive predictive value for predicting macrosomia in these studies was slightly lower at 44% and 52%. The purpose of this study was to develop a mathematical model to improve the GAP method in predicting macrosomia.
Methods: A total of 411 singleton pregnancies delivered after 37 weeks’ gestation that had undergone an ultrasonographic examination between 34 and 36.9 weeks’ gestation were reviewed. For each woman, the GAP method was used to estimate birth weight. Error in the GAP method was calculated by comparing the estimated fetal weight to the actual birth weight. A correction factor was derived for the GAP method and then applied to a new population of 317 patients.
Results: The study’s model improved specificity for macrosomia in both the derivation and verification groups but the change in sensitivity for macrosomia was not significant.
Conclusions: The false-positive rates of macrosomia were significantly reduced using the study’s corrected GAP method.
Performance of 36 different weight estimation formulae for fetuses with macrosomia
M. Hoopmann, H. Abele, N. Wagner, D. Wallwiener, K. O. Kagan
Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
Fetal Diagn Ther 2010; 27: 204–13
Background: Several studies have shown continuously high errors in predicting birth weight in macrosomic fetuses. This study aimed to compare 36 commonly used weight-estimating formulae in predicting the weight of fetuses of 4000 g or more.
Methods: This was a retrospective study of women with singleton pregnancies that resulted in a fetus weighing 4000 g or more. All pregnant women were given an ultrasound examination shortly before delivery and these data were plugged into the different formulae. The accuracy of the formulae was compared by mean percentage error and mean absolute percentage error, by the frequency distribution of differences between estimated fetal weight and fetal birth weight, and by comparing detection and false-positive rates in screening for fetuses at various weights.
Results: Mean percentage error ranged from −62.2% to 9.6% and was closest to zero with the Hart formula. Mean absolute percentage error was 10% or less with 12 of the 36 formulae and smallest with the Hart formula at 3.9%. The mean detection rate among all formulae for fetuses with a birth weight greater than or equal to 4000, 4300 and 4500 g was 29%, 24% and 22% respectively.
Conclusions: Some formulae showed advantages over others but none reached a detection rate and false-positive rate good enough for clinical recommendation.
- • Comment: The derivation of an accurate weight estimation formula is crucial in predicting and controlling fetal macrosomia. Among the 36 different weight estimation formulae, none displayed results that stood out. The corrected GAP method from the first study, however, did show decreased false-positive rates and increased positive predicting values for predicting macrosomia. This corrected GAP method needs to be studied further in different patient populations.
Weekly compared with daily blood glucose monitoring in women with diet-treated gestational diabetes
J. S. Hawkins, B. M. Casey, J. Y. Lo, K. Moss, D. D. McIntire, K. J. Leveno
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
Obstet Gynecol 2009; 113: 1302–12
Background: Self-monitoring of blood glucose in pregnant woman with overt diabetes has been associated with improved glycaemic control and improved neonatal outcomes. This study aimed to determine whether daily blood glucose self-monitoring compared to weekly office testing in women with diet-treated gestational diabetes reduces cases of macrosomia.
Methods: The design was a retrospective cohort study of women with diet-treated GDM between January 1991 and March 2001. Initially, the standard treatment for women with diet-treated GDM at the Parkland Memorial Hospital included routine office monitoring of fasting blood glucose levels. Beginning in 1998, four times daily blood glucose self-monitoring became the standard treatment. Women in these groups were compared in two outcomes of interest including frequency of macrosomia and large-for-gestational-age infants.
Results: A total of 315 women who used daily blood glucose self-monitoring were compared to 675 women who underwent weekly office-based glucose testing. The self-monitoring groups had fewer macrosomia and large-for-gestational-age neonates and gained significantly less weight.
Conclusions: Daily blood glucose self-monitoring, compared to weekly office-based testing, is associated with a reduction in the incidence of macrosomia.
- • Comments: This study shows further evidence that self-monitoring of blood glucose in pregnancy improves neonatal outcomes, such as macrosomia and large-for-gestational-age infants. This can be a costly treatment method but, as shown by this and numerous other studies, glucose meters are an essential device in the treatment of gestational diabetes.
Comparison in the performance of glucose meters in blood glucose during pregnancy
G. W. S. Kong,1W. H. Tam,1M. H. M. Chan,2W. Y. So,3C. W. K. Lam,2I. P. I. C. Yiu,1K. M. Loo,3C. Y. Li1
1Departments of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong, SAR, China,2Chemical Pathology, Prince of Wales Hospital, Hong Kong, SAR, China, and3Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, SAR, China
Gynecol Obstet Invest 2010; 69: 264–9
Background: As home blood glucose monitoring forms an essential part in achieving glycaemic control in pregnancies, the accuracy of these meters becomes an important part of this assessment. The glycaemic range for pregnancies demands a lower range than that for a typical diabetic patient. Furthermore, there is limited data describing how accurately these meters perform during pregnancy. This study aimed to compare the performance of four of the latest glucose meters during pregnancy.
Methods: Four glucose meters were tested on 208 women with GDM. The four meters were Ascensia EliteF, Accu-Chek Advantage II, CareSens 505B and Optium. Each subject underwent simultaneous finger prick capillary blood glucose testing with venipunctures. The performance of the four different meters was compared using error grid analysis. A Bland–Altman plot was also used to assess the agreement between the glucose meter readings and the plasma glucose values.
Results: Elite, Advantage II and CareSens had more than 90% of readings in the acceptable target range for error grid analysis. CareSens had the lowest mean bias by Bland–Altman analysis while Advantage II had the highest proportion of readings within 5% difference from plasma glucose.
Conclusions: The performance of the four meters appeared very similar.
- • Comment: Patients today want the best care possible, and as a result they are often concerned to get the best possible glucose meters. This study shows that the differences between these meters during pregnancies are very minor and that there is no need for the patient to worry. The most important thing for doctors to do is inform their patients of the need for self-monitoring of blood glucose.