Update on Management of Gestational Diabetes Mellitus and the Role of Continuous Glucose Monitor Technology.

Abstract

Gestational diabetes mellitus (GDM) complicates 5%-25% of pregnancies worldwide and is the most prevalent metabolic complication of pregnancy. Risk factors for GDM include maternal obesity, advanced maternal age, family history of type 2 diabetes mellitus (T2DM), diagnosis of Polycystic ovarian syndrome (PCOS), and a prior history of GDM. GDM has both implications for the pregnant person and the offspring with increased risks of adverse pregnancy outcomes as well as increased chance of developing T2DM later in life. The first-line treatment for GDM includes behavior modification followed by pharmacologic therapy with insulin being preferred medication of choice. Standard of care for the management of continuous glucose monitors (CGM) currently includes self-monitored blood glucoses or finger sticks 4× per day and this can increase stress and anxiety in pregnancies. Continuous glucose monitorings have been used commonly in nonpregnant diabetic patients and patients with type 1 diabetes but their use in patients with GDM are increasing. Although there are no specific Continuous glucose monitoring targets for patients with GDM, CGMs have been used to help determine normative data in patients without GDM, which has helped provide expert opinion on GDM targets. In research studies, CGMs have also been used to explore glycemic profiles for patients early in pregnancy who go on to develop GDM as well as looking at adverse pregnancy outcomes in patients with higher Continuous glucose monitoring metrics. Using CGMs has the potential to provide more information about glycemia, ultimately leading to treatment recommendations in patients with GDM with the ultimate goal to improve adverse pregnancy outcomes and improve health and well-being at large.