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. 2019 May 23;5(5):CD009613.
doi: 10.1002/14651858.CD009613.pub4.

Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes

Leanne V Jones  1 , Amita Ray, Foong Ming Moy, Brian S Buckley
Affiliations

Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes

Leanne V Jones et al. Cochrane Database Syst Rev. .

Abstract

Background: There are a number of ways of monitoring blood glucose in women with diabetes during pregnancy, with self-monitoring of blood glucose (SMBG) recommended as a key component of the management plan. No existing systematic reviews consider the benefits/effectiveness of different techniques of blood glucose monitoring on maternal and infant outcomes among pregnant women with pre-existing diabetes. The effectiveness of the various monitoring techniques is unclear. This review is an update of a review that was first published in 2014 and subsequently updated in 2017.

Objectives: To compare techniques of blood glucose monitoring and their impact on maternal and infant outcomes among pregnant women with pre-existing diabetes.

Search methods: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 November 2018), and reference lists of retrieved studies.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs comparing techniques of blood glucose monitoring including SMBG, continuous glucose monitoring (CGM), automated telemedicine monitoring or clinic monitoring among pregnant women with pre-existing diabetes mellitus (type 1 or type 2). Trials investigating timing and frequency of monitoring were also eligible for inclusion. RCTs using a cluster-randomised design were eligible for inclusion but none were identified.

Data collection and analysis: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach.

Main results: This review update includes a total of 12 trials (863) women (792 women with type 1 diabetes and 152 women with type 2 diabetes). The trials took place in Europe, the USA and Canada. Three of the 12 included studies are at low risk of bias, eight studies are at moderate risk of bias, and one study is at high risk of bias. Four trials reported that they were provided with the continuous glucose monitors free of charge or at a reduced cost by the manufacturer.Continuous glucose monitoring (CGM) versus intermittent glucose monitoring, (four studies, 609 women)CGM may reduce hypertensive disorders of pregnancy (pre-eclampsia and pregnancy-induced hypertension) (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.39 to 0.85; 2 studies, 384 women; low-quality evidence), although it should be noted that only two of the four relevant studies reported data for this composite outcome. Conversely, this did not translate into a clear reduction for pre-eclampsia (RR 0.65, 95% CI 0.39 to 1.08; 4 studies, 609 women, moderate-quality evidence). There was also no clear reduction in caesarean section (average RR 0.94, 95% CI 0.75 to 1.18; 3 studies, 427 women; I2 = 41%; moderate-quality evidence) or large-for-gestational age (average RR 0.84, 95% CI 0.57 to 1.26; 3 studies, 421 women; I2 = 70%; low-quality evidence) with CGM. There was not enough evidence to assess perinatal mortality (RR 0.82, 95% CI 0.05 to 12.61, 71 infants, 1 study; low-quality evidence), or mortality or morbidity composite (RR 0.80, 95% CI 0.61 to 1.06; 1 study, 200 women) as the evidence was based on single studies of low quality. CGM appears to reduce neonatal hypoglycaemia (RR 0.66, 95% CI 0.48 to 0.93; 3 studies, 428 infants). Neurosensory disability was not reported.Other methods of glucose monitoringFor the following five comparisons, self-monitoring versus a different type of self-monitoring (two studies, 43 women); self-monitoring at home versus hospitalisation (one study, 100 women), pre-prandial versus post-prandial glucose monitoring (one study, 61 women), automated telemedicine monitoring versus conventional system (three studies, 84 women), and constant CGM versus intermittent CGM (one study, 25 women), it is uncertain whether any of the interventions has any impact on any of our GRADE outcomes (hypertensive disorders of pregnancy, caesarean section, large-for-gestational age) because the quality of the evidence was found to be very low. This was due to evidence largely being derived from single trials, with design limitations and limitations with imprecision (wide CIs, small sample sizes, and few events). There was not enough evidence to assess perinatal mortality and neonatal mortality and morbidity composite. Other important outcomes, such as neurosensory disability, were not reported in any of these comparisons.

Authors' conclusions: Two new studies (406 women) have been incorporated to one of the comparisons for this update. Although the evidence suggests that CGM in comparison to intermittent glucose monitoring may reduce hypertensive disorders of pregnancy, this did not translate into a clear reduction for pre-eclampsia, and so this result should be viewed with caution. No differences were observed for other primary outcomes for this comparison. The evidence base for the effectiveness of other monitoring techniques analysed in the other five comparisons is weak and based on mainly single studies with very low-quality evidence. Additional evidence from large well-designed randomised trials is required to inform choices of other glucose monitoring techniques and to confirm the effectiveness of CGM.

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Conflict of interest statement

Foong Ming Moy: none known.

Amita Ray: none known.

Brian Buckley: none known.

Leanne Jones: is employed by the University of Liverpool as an Associate Editor/Deputy Managing Editor with Cochrane Pregnancy and Childbirth. Her employment is supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Pregnancy and Childbirth. She had no involvement with the editorial processes for this review update. Cochrane Pregnancy and Childbirth received an award from UK NIHR Cochrane Reviews of NICE Priority: Project Ref NIHR 128651, to update this review.

Figures

1
1
Study flow diagram 2018
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 1 Hypertensive disorders of pregnancy.
1.2
1.2. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 2 Caesarean section.
1.3
1.3. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 3 Large‐for‐gestational age.
1.4
1.4. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 4 Perinatal mortality (stillbirth and neonatal mortality).
1.5
1.5. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 5 Mortality or morbidity composite (pregnancy loss (miscarriage, stillbirth, and neonatal death); birth injury; neonatal glycaemia; hyperbilirubinaemia; respiratory distress; and high level neonatal care of more than 24 hours).
1.6
1.6. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 6 Pre‐eclampsia.
1.7
1.7. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 7 Pregnancy‐induced hypertension.
1.8
1.8. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 8 Behaviour changes associated with the intervention (range of score 10‐50 ‐ high score= greater fear of hypoglycaemia).
1.9
1.9. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 9 Sense of well‐being and quality of life (Short form 12 (SF‐12), total score at 34 weeks' gestation).
1.10
1.10. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 10 Sense of well‐being and quality of life (Problem areas in diabetes (PAID), total score at 34 weeks' gestation).
1.11
1.11. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 11 Sense of well‐being and quality of life (BGMSRQ, total score at 34 weeks' gestation).
1.12
1.12. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 12 Glycaemic control ‐ Maternal HbA1c.
1.13
1.13. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 13 Glycaemic control ‐ Achieved maternal HbA1c <= 6.5% (48 mmol/mol) at 34 weeks.
1.14
1.14. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 14 Maternal hypoglycaemia (severe).
1.15
1.15. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 15 Miscarriage.
1.16
1.16. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 16 Stillbirth.
1.17
1.17. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 17 Neonatal mortality.
1.18
1.18. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 18 Gestational age at birth.
1.19
1.19. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 19 Preterm birth < 37 weeks.
1.20
1.20. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 20 Preterm birth < 34 weeks.
1.21
1.21. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 21 Macrosomia.
1.22
1.22. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 22 Birthweight.
1.23
1.23. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 23 Small‐for‐gestational age.
1.24
1.24. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 24 Head circumference (cm).
1.25
1.25. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 25 Length (crown‐heel length cm).
1.26
1.26. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 26 Adiposity (sum of 4 skin folds (tricepts, subscapular, biceps, flank) mm).
1.27
1.27. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 27 Shoulder dystocia.
1.28
1.28. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 28 Respiratory distress syndrome.
1.29
1.29. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 29 Neonatal hypoglycaemia.
1.30
1.30. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 30 Neonatal hyperbilirubinaemia.
1.31
1.31. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 31 Relevant biomarker changes associated with the intervention (cord blood c‐peptide levels > 566 pmol/L).
1.32
1.32. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 32 Relevant biomarker changes associated with the intervention (cord blood c‐peptide levels > 2725 pmol/L).
1.33
1.33. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 33 Major and minor anomalies.
1.34
1.34. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 34 Number of hospital admissions (mother).
1.35
1.35. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 35 Neonatal intensive care unit admissions.
1.36
1.36. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 36 Neonatal intensive care unit length of admission > 24 hours.
1.37
1.37. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 37 Birth trauma (shoulder dystocia, bone fracture, nerve palsy).
1.38
1.38. Analysis
Comparison 1 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 38 Diabetic ketoacidosis (mother).
2.1
2.1. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 1 Caesarean section.
2.2
2.2. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 2 Perinatal mortality (stillbirth and neonatal mortality).
2.3
2.3. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 3 Glycaemic control during/end of treatment (maternal post‐prandial blood glucose).
2.4
2.4. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 4 Glycaemic control during/end of treatment (maternal HbA1c).
2.5
2.5. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 5 Miscarriage.
2.6
2.6. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 6 Neonatal mortality.
2.7
2.7. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 7 Gestational age at birth.
2.8
2.8. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 8 Birthweight.
2.9
2.9. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 9 Respiratory distress syndrome.
2.10
2.10. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 10 Neonatal hypoglycaemia.
2.11
2.11. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 11 Neonatal jaundice (hyperbilirubinaemia).
2.12
2.12. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 12 Neonatal hypocalcaemia.
2.13
2.13. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 13 Neonatal polycythaemia.
2.14
2.14. Analysis
Comparison 2 Self‐monitoring versus different type of self monitoring, Outcome 14 Neonatal cord vein C‐peptide.
3.1
3.1. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 1 Hypertensive disorders of pregnancy.
3.2
3.2. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 2 Caesarean section.
3.3
3.3. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 3 Perinatal mortality (stillbirth and neonatal mortality).
3.4
3.4. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 4 Pre‐eclampsia.
3.5
3.5. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 5 Pregnancy‐induced hypertension.
3.6
3.6. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 6 Placental abruption.
3.7
3.7. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 7 Preterm birth < 37 weeks.
3.8
3.8. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 8 Respiratory distress syndrome.
3.9
3.9. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 9 Neonatal hypoglycaemia.
3.10
3.10. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 10 Neonatal jaundice (hyperbilirubinaemia).
3.11
3.11. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 11 Major anomalies.
3.12
3.12. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 12 Antenatal hospital admission.
3.13
3.13. Analysis
Comparison 3 Self‐monitoring at home versus hospitalisation, Outcome 13 Feeding difficulties (not pre‐specified).
4.1
4.1. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 1 Caesarean section.
4.2
4.2. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 2 Large‐for‐gestational age.
4.3
4.3. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 3 Perinatal mortality (stillbirth and neonatal mortality).
4.4
4.4. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 4 Pre‐eclampsia.
4.5
4.5. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 5 Weight gain during pregnancy.
4.6
4.6. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 6 Insulin dose.
4.7
4.7. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 7 Glycaemic control ‐ Insulin dose.
4.8
4.8. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 8 Glycaemic control ‐ HbA1c.
4.9
4.9. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 9 Stillbirth.
4.10
4.10. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 10 Gestational age at birth.
4.11
4.11. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 11 Preterm birth < 37 weeks.
4.12
4.12. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 12 Macrosomia.
4.13
4.13. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 13 Birthweight.
4.14
4.14. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 14 Adiposity ‐ Subscapula skinfold thickness.
4.15
4.15. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 15 Adiposity ‐ Triceps skinfold thickness.
4.16
4.16. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 16 Birth trauma (shoulder dystocia, bone fracture, nerve palsy) (not pre‐specified as a composite).
4.17
4.17. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 17 Respiratory distress syndrome.
4.18
4.18. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 18 Neonatal hypoglycaemia.
4.19
4.19. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 19 Neonatal jaundice (hyperbilirubinaemia).
4.20
4.20. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 20 Cord IGF‐1.
4.21
4.21. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 21 Neonatal glucose at age 1 hour (not pre‐specified).
4.22
4.22. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 22 Transient tachypnea (not pre‐specified).
4.23
4.23. Analysis
Comparison 4 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 23 Neonatal intensive care admissions.
5.1
5.1. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 1 Caesarean section.
5.2
5.2. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 2 Neonatal morbidity composite.
5.3
5.3. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 3 Gestational age at birth.
5.4
5.4. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 4 Use of additional insulin therapy.
5.5
5.5. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 5 Insulin requirement at end of study.
5.6
5.6. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 6 Glycaemic control ‐ Maternal fasting blood glucose: before breakfast.
5.7
5.7. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 7 Glycaemic control ‐ Maternal fasting blood glucose: before lunch.
5.8
5.8. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 8 Glycaemic control ‐ Maternal HbA1c.
5.9
5.9. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 9 Glycaemic control ‐ Maternal post‐prandial blood glucose.
5.10
5.10. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 10 Weight gain during pregnancy [kg].
5.11
5.11. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 11 Macrosomia.
5.12
5.12. Analysis
Comparison 5 Automated telemedicine monitoring versus conventional, Outcome 12 Birthweight.
6.1
6.1. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 1 Caesarean section.
6.2
6.2. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 2 Weight gain during pregnancy.
6.3
6.3. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 3 Insulin dosage, 3rd trimester (IU/kg/day).
6.4
6.4. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 4 Glycaemic control ‐ Maternal blood glucose (1st trimester).
6.5
6.5. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 5 Glycaemic control ‐ Maternal blood glucose (3rd trimester).
6.6
6.6. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 6 Glycaemic control ‐ Maternal HbA1c (1st trimester).
6.7
6.7. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 7 Glycaemic control ‐ Maternal HbA1c (3rd trimester).
6.8
6.8. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 8 Maternal hypoglycemia.
6.9
6.9. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 9 Diabetic ketoacidosis (not pre‐specified).
6.10
6.10. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 10 Preterm birth < 37 weeks.
6.11
6.11. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 11 Macrosomia.
6.12
6.12. Analysis
Comparison 6 Constant CGM versus intermittent CGM, Outcome 12 Neonatal hypoglycaemia.
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Update of

References

References to studies included in this review

Dalfrà 2009 {published data only}
    1. Dalfrà MG, Nicolucci A, Lapolla A, TISG. The effect of telemedicine on outcome and quality of life in pregnant women with diabetes. Journal of Telemedicine & Telecare 2009;15(5):238‐42. - PubMed
di Biase 1997 {published data only}
    1. Fallucca F, DiBiase N, Sabbatini A, Borrello E, Sciullo E, Napoli A. Telemedicine in the treatment of diabetic pregnancy. Practical Diabetes International. 1996;13(4):115‐8.
    1. Biase N, Napoli A, Sabbatini A, Borrello E, Buongiorno AM, Fallucca F. Telemedicine in the treatment of diabetic pregnancy. Annali dell Istituto Superiore di Sanita 1997;33(3):347‐51. - PubMed
Feig 2017 {published data only}
    1. Farrell A, Mergler S, Mason D, Sanchez J, Feig DS, Asztalos E. The use of logs and forms for the tracking of RT‐CGM devices in the CONCEPTT Trial. Clinical Trials 2013;10:S80.
    1. Feig DS, Asztalos E, Corcoy R, Leiva A, Donovan L, Hod M, et al. CONCEPTT: Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial: A multi‐center, multi‐national, randomized controlled trial ‐ Study protocol. BMC Pregnancy and Childbirth 2016;16(1):167. [PUBMED: 27430714] - PMC - PubMed
    1. Feig DS, Donovan LE, Corcoy R, Murphy KE, Amiel SA, Hunt KF, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes (conceptt): a multicentre international randomised controlled trial. Lancet 2017;390(10110):2347‐59. - PMC - PubMed
    1. NCT01788527. Continuous glucose monitoring in women with type 1 diabetes in pregnancy trial (CONCEPTT). clinicaltrials.gov/show/NCT01788527 Date first received: 19 December 2012.
Hanson 1984 {published data only}
    1. Hanson U, Persson B, Enochsson E, Lennerhagen P, Lindgren F, Lundstrom V, et al. Self‐monitoring of blood glucose by diabetic women during the third trimester of pregnancy. American Journal of Obstetrics and Gynecology 1984;150:817‐21. - PubMed
Manderson 2003 {published data only}
    1. Manderson J, Ennis C, Patterson C, Hadden D, Traub A. Pre‐eclampsia in type 1 diabetic pregnancy: preprandial versus postprandial capillary blood glucose monitoring. Hypertension in Pregnancy 2002;21(Suppl 1):142.
    1. Manderson JG, Patterson CC, Hadden DR, Traub AI, Ennis C, McCance DR. Preprandial versus postprandial blood glucose monitoring in type 1 diabetic pregnancy: a randomized controlled clinical trial. American Journal of Obstetrics and Gynecology 2003;189:507‐12. - PubMed
Murphy 2008 {published data only}
    1. ISRCTN84461581. A randomised controlled trial to evaluate the role of the continuous glucose monitoring system (CGMS) in pregnancies complicated by pre‐existing diabetes. isrctn.com/ISRCTN84461581 Date first received: 30 September 2005.
    1. Murphy HR, Rayman G, Duffield K, Lewis KS, Kelly S, Johal B, et al. Changes in the glycemic profiles of women with type 1 and type 2 diabetes during pregnancy. Diabetes Care 2007;30(11):2785‐91. - PubMed
    1. Murphy HR, Rayman G, Lewis K, Kelly S, Johal B, Duffield K, et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ 2008;337:a1680. - PMC - PubMed
Petrovski 2011 {published data only}
    1. Petrovski G, Dimitrovski C, Bogoev M, Milenkovic T, Ahmeti I, Bitovska I. Is there a difference in pregnancy and glycemic outcome in patients with type 1 diabetes on insulin pump with constant or intermittent glucose monitoring? A pilot study. Diabetes Technology and Therapeutics 2011;13(11):1109‐13. - PubMed
Secher 2013 {published data only}
    1. Cordua S, Secher AL, Ringholm L, Damm P, Mathiesen ER. Real‐time continuous glucose monitoring during labour and delivery in women with type 1 diabetes ‐ observations from a randomized controlled trial. Diabetic Medicine 2013;30(11):1374‐81. - PubMed
    1. NCT00994357. The effect of real‐time continuous glucose monitoring on severe complications to pregnancy in women with diabetes: a randomised controlled study. clinicaltrials.gov/show/NCT00994357 Date first received: 13 October 2009.
    1. Secher AL, Mathiesen ER, Andersen HU, Peter D, Lene R. Severe hypoglycemia in pregnant women with type 2 diabetes‐ a relevant clinical problem. Diabetes Research and Clinical Practice 2013;102(2):e17‐8. - PubMed
    1. Secher AL, Ringholm L, Andersen HU, Damm P, Mathiesen ER. The effect of real‐time continuous glucose monitoring in diabetic pregnancy ‐ a randomised controlled trial. Diabetologia 2012;55(Suppl 1):S40.
    1. Secher AL, Ringholm L, Andersen HU, Damm P, Mathiesen ER. The effect of real‐time continuous glucose monitoring in pregnant women with diabetes: a randomized controlled trial. Diabetes Care 2013;36:1877‐83. - PMC - PubMed
Stubbs 1980 {published data only}
    1. Stubbs SM, Alberti KG, Brudenell JM, Pyke DA, Watkins PJ, Stubbs WA. Management of the pregnant diabetic: home or hospital, with or without glucose meters. Lancet 1980;1:1122‐4. - PubMed
Varner 1983 {published data only}
    1. Varner MW. Efficacy of home glucose monitoring in diabetic pregnancy. American Journal of Medicine 1983;75:592‐6. - PubMed
Voormolen 2018 {published data only}
    1. Evers I. Effectiveness of continuous glucose monitoring during diabetic pregnancy (GlucoMOMS trial); a randomised controlled trial. Diabetes Technology and Therapeutics 2016;18:A13‐A14. - PMC - PubMed
    1. Voormolen DN, DeVries JH, Franx A, Mol BW, Evers IM. Effectiveness of continuous glucose monitoring during diabetic pregnancy (GlucoMOMS trial); a randomised controlled trial. BMC Pregnancy and Childbirth 2012;12:164. - PMC - PubMed
    1. Voormolen DN, DeVries JH, Sanson RM, Heringa MP, Valk HW, Kok M, et al. Continuous glucose monitoring during diabetic pregnancy (GlucoMOMS): a multicentre randomized controlled trial. Diabetes, Obesity & Metabolism 2018;20(8):1894‐902. - PubMed
    1. Voormolen DN, Heringa MP, Naaktgeboren CA, Franx A, DeVries JH, Kok M, et al. Efficacy of continuous glucose monitoring in diabetic pregnancy, the glucomoms trial. American Journal of Obstetrics and Gynecology 2017;216(1):S288, Abstract no: 488.
Wojcicki 2001 {published data only}
    1. Ladyzynski P, Wojcicki JM. Home telecare during intensive insulin treatment‐‐metabolic control does not improve as much as expected. Journal of Telemedicine and Telecare 2007;13(1):44‐7. - PubMed
    1. Wojcicki JM, Ladyzynski P, Krzymien J, Jozwicka E, Blachowicz J, Janczewska E, et al. What we can really expect from telemedicine in intensive diabetes treatment: results from 3‐year study on type 1 pregnant diabetic women. Diabetes Technology & Therapeutics 2001;3(4):581‐9. - PubMed

References to studies excluded from this review

Bartholomew 2011 {published data only}
    1. Bartholomew LM, Soules K, Church K, Shaha S, Burlingame J, Graham G, et al. Managing diabetes in pregnancy using cell phone/internet technology. Clinical Diabetes 2015;33(4):169‐74. - PMC - PubMed
    1. Bartholomew ML, Church K, Graham G, Burlingame J, Zalud I, Sauvage L, et al. Managing diabetes in pregnancy using cell phone/internet technology. American Journal of Obstetrics and Gynecology 2011;204(1 Suppl):S113‐S114.
    1. NCT01907516. Managing diabetes in pregnancy using cell phone/internet technology. clinicaltrials.gov/show/NCT01907516 Date first received: 22 July 2013.
NCT01630759 {published data only}
    1. NCT01630759. Remote monitoring of diabetes in pregnancy: a feasibility study for a randomised controlled trial. clinicaltrials.gov/show/NCT01630759 Date first received: 22 June 2012.
Temple 2006 {published data only}
    1. Temple RC, Duffield K, Lewis K, Murphy HR. Glycaemic control during pregnancy in women with long duration type 1 diabetes: lessons learn using continuous glucose monitoring systems. Diabetologia 2006;49(Suppl 1):S78.
Walker 1999 {published data only}
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References to ongoing studies

Link 2018 {published data only}
    1. Link H, NCT03504592. Utilizing mHealth to improve diabetes in an obstetric population. https://clinicaltrials.gov/ct2/show/NCT03504592 (first received 20 April 2018).
Logan 2011 {published data only}
    1. Logan AG, NCT01474525. Managing diabetes during pregnancy in the wireless age: a RCT of glucose telemonitoring. https://clinicaltrials.gov/ct2/show/NCT01474525 (first received 18 November 2011).

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References to other published versions of this review

Moy 2012
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