Scientific rationale for management of diabetes in pregnancy. Recent approaches with innovative computer-based technology.
A series of recent studies in women with gestational diabetes mellitus is reviewed. During the studies, which were designed to gain a better understanding of the etiology of perinatal morbidity, a novel means of collecting ambulatory blood glucose values was employed. Subjects used specially modified reflectance meters with onboard memories to record each value with corresponding time and date. The data were transmitted to a microcomputer and rapidly analyzed to permit effective follow-up in the study population. The system enabled the investigators to characterize metabolic control, evaluate different treatment modalities, and measure the association between glycemic control and fetal outcome. These studies indicate that patients with one elevated blood glucose value during formal glucose tolerance testings have higher blood glucose values under ambulatory conditions. Furthermore, these elevated ambulatory glucose values were significantly correlated with fetal macrosomia. Treatment regimens designed to lower verified ambulatory blood glucose measurements may help reduce fetal macrosomia in women with milder forms of gestational diabetes or in women with relative glucose intolerance without a substantial increase in severe hypoglycemia.
Langer
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Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York 10461.
D015190:Blood Glucose Self-Monitoring; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000628:therapy*; D013813:Therapy, Computer-Assisted
D007328:Insulin