Use of real time continuous glucose monitoring and intravenous insulin in type 1 diabetic mothers to prevent respiratory distress and hypoglycaemia in infants.
BACKGROUND
Pregnancy in Type 1 diabetic patients is a precarious condition, both for mother and fetus with increased the risk of prematurity and, immediately after delivery with risk of respiratory distress syndrome and hypoglycaemia in newborns. A strict control and monitoring of diabetes throughout pregnancy is important in reducing the impact of the disease on the fetus and newborn. In recent years many new technologies have been introduced to ameliorate diabetes monitoring, where the last is the Real-time Continuous Glucose Monitoring System (RT-CGMS).


METHODS
In the last three years, 72 h continuous glucose monitoring system (RT-CGMS) (Medtronic, CA) was performed in 18 pregnant women with Type 1 diabetes in two moments of pregnancy: during treatment with betamethasone to prevent respiratory distress and during delivery. In both cases insulin was administered intravenous and the dose was changed on the basis of glycaemia.


RESULTS
The results present the use of this new technique during two topics moments of pregnancy of type 1 diabetes patients when is very important intensively to monitor diabetes and to obtain the well being of the fetus. No infant experimented hypoglycaemia or respiratory distress syndrome at the moment and in the first hours after the birth.


CONCLUSIONS
We wish to stress the importance reducing glycaemia during administration of betamethasone and during labor. It is conceivable that the scarce attention paid to monitoring glucose levels in diabetic mothers during labor in gynaecological world may be due to the difficulty in glucose monitoring with the devices until now available. Hopefully, our anecdotal account may prompt improvements with RT-CGMS, and may lead to a better approach to the problem, thereby changing the prognosis of infants born to diabetic mothers.
Iafusco
Dario
D
Department of Paediatrics, Second University of Naples, Italy. dario.iafusco@unina2.it
Stoppoloni
Fabrizio
F
Salvia
Gennaro
G
Vernetti
Gilberto
G
Passaro
Patrizia
P
Petrovski
Goran
G
Prisco
Francesco
F
D000293:Adolescent; D000328:Adult; D001623:Betamethasone / Q000494:pharmacology; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005315:Fetal Diseases / Q000517:prevention & control; D005938:Glucocorticoids / Q000494:pharmacology; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control; D007262:Infusions, Intravenous; D007328:Insulin / Q000627:therapeutic use*; D008991:Monitoring, Physiologic / Q000379:methods*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000188:drug therapy* / Q000378:metabolism; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control; D016896:Treatment Outcome
D001786:Blood Glucose; D005938:Glucocorticoids; D007004:Hypoglycemic Agents; D007328:Insulin; D001623:Betamethasone