Monitoring Of Pregnant Women Research Articles

The Efficacy and Acceptability of Flash Glucose Monitoring in Pregnant Women with Gestational Diabetes Mellitus: A Systematic Review

Background: Gestational diabetes mellitus (GDM) occurs in approximately 9% of pregnancies, and proper glycemic control is of utmost importance in the prevention of GDM-associated obstetric complications. Flash glucose monitoring (FGM), a subtype of continuous glucose monitoring (CGM), offers intermittent blood glucose scanning and is considered a propitious alternative to the standard method of self-monitoring of blood glucose (SMBG). Aim: The aim of this review was to systematically assess the efficacy and acceptability of FGM in in pregnancies complicated by GDM. Methods: A systematic literature search was performed in the PubMed, MEDLINE, Scopus, and Cochrane databases. The review was conducted following the PRISMA guidelines, and the study protocol has been registered in the PROSPERO database with the registration number CRD42024545874. Results: A total of 872 articles were initially identified, 141 publications underwent an in-depth full-text analysis, resulting in 133 studies being excluded from further assessment. Eventually, eight studies were included in the analysis. Conclusions: The analysis revealed that FGM is a safe and efficient method of glycemic control in GDM. The majority of the studies consider its accuracy comparable to SMBG. Furthermore, FGM is well accepted by patients with numerous advantages in user-friendliness over SMBG.

Intraoperative neuromonitoring of visual evoked potentials in a pregnant patient with meningioma: a case report

BackgroundMeningioma in the parasellar region may lead to visual impairment, so intraoperative neurological monitoring is essential for enucleation surgery. However, intraoperative neurological monitoring in pregnant women is challenging, as the anesthesia management must consider the effects and risks to the fetus. Remimazolam is a newly introduced intravenous anesthetic that has little effect on blood pressure. However, the effects of remimazolam on intraoperative neuromonitoring are little known. We treated a pregnant patient with parasellar meningioma who developed visual impairment, using remimazolam for anesthesia and intraoperative neurophysiological monitoring of the visual evoked potential.Case presentationA 34-year-old woman who was 20 weeks pregnant presented with visual acuity disturbances. Neuroimaging demonstrated a parasellar meningioma, and rapid tumor growth and worsening of symptoms subsequently occurred. Craniotomy for tumor removal was performed under anesthesia with remimazolam, which allowed monitoring of the visual evoked potentials. Her visual acuity was restored postoperatively, and no adverse events occurred in the fetus.ConclusionOur experience with intraoperative neuromonitoring of a pregnant woman in the third trimester showed that anesthesia with remimazolam allows safe brain surgery combined with intraoperative visual evoked potential monitoring. Further research is needed to determine the effects of remimazolam on the fetus, as well as the safe dosage and duration of exposure.

Incidence of serious maternal Morbidity at the RUASHI military hospital (DRC)

Maternal morbidity is a public health problem in developing countries. The aim of our study was to determine the frequency of serious maternal morbidity at the Ruashi military hospital (DRC) with a view to ensuring good care and monitoring of pregnant women. A longitudinal descriptive study was conducted among 154 pregnant women in a prospective manner, data entry and analysis of results were carried out using Microsoft office 2016 and statistical test parameters were made using of Epi Info 7.2. The incidence of maternal morbidity was 24.2%, of which 32.4% had anemia followed by hemorrhage with 27% and finally sepsis and uterine subinvolution with 5.4% each. However, 94.6% had followed the prenatal consultation against 5.4% and 29.7% had a frequency of 3 participations in the prenatal consultation and finally 8.1% had a frequency of 6 participations in the CPN. The analysis showed that the frequency of prenatal consultation and postnatal visits, literacy and socio-economic level are statistically associated with maternal morbidity. Improving the socio-economic level of households, combating illiteracy and monitoring prenatal consultation are among the factors that will determine maternal morbidity.

The Relationship between Body Mass Index and Frontal QRS-T Angle in Pregnant Women Undergoing Cesarean Section with Spinal Anesthesia.

Background and objectives: The frontal QRS-T angle is a novel parameter of myocardial repolarization. Weight gain during pregnancy and physiological changes during a cesarian section may affect the frontal QRS-T angle. We aimed to assess the effect of body mass index (BMI) on the frontal QRS-T angle in pregnant women undergoing cesarean section with spinal anesthesia. Method and materials: This study included 90 pregnant women. BMI was calculated for all pregnant women. The study population was divided into two groups: BMI < 30 (n = 66) and BMI ≥ 30 (n = 24). QT interval measurements and the frontal QRS-T angle were obtained from the report of an electrocardiography machine. Results: It was found that the pre-operative and post-operative frontal QRS-T angle (p = 0.045 and p = 0.007) and QTc interval (p = 0.037 and p < 0.001) were higher in pregnant women with a BMI ≥ 30 than in pregnant women with a BMI < 30. In addition, when compared to pre-operative values, the post-operative frontal QRS-T angle (from 24.0 [20.0-41.5] to 34.5 [19.5-50.0], p = 0.031) and QTc interval (from 420.6 ± 13.3 to 431.7 ± 18.3, p = 0.010) were increased in the BMI ≥ 30 group, whereas no significant post-operative increase was observed in the BMI < 30 group. In correlation analysis, BMI was positively correlated with the frontal QRS-T angle and QTc interval. Conclusions: The frontal QRS-T angle and QTc interval were importantly increased in pregnant women with a BMI ≥ 30 than in pregnant women with a BMI < 30. Also, after cesarean section operation with spinal anesthesia, the frontal QRS-T angle and QTc were increased significantly in the BMI ≥ 30 group, whereas no significant change was observed in the BMI < 30 group. Therefore, it is suggested to perform close post-operative monitoring in pregnant women with a BMI ≥ 30 undergoing cesarean section with spinal anesthesia.

Continuous glucose monitoring in pregnant women with pregestational type 2 diabetes: a narrative review.

Background: Type 2 diabetes (T2DM) in pregnancy is associated with poor perinatal outcomes; however, there are limited data on outcomes of continuous glucose monitoring (CGM) use in this population. Objective: We reviewed the literature on studies reporting CGM outcomes in pregnant women with T2DM. We aimed to synthesise in a narrative review, the effects of CGM on glycaemic and perinatal outcomes as well as current research gaps. Results: Of 34 articles screened, three reported CGM outcomes in T2DM pregnancies compared to self-monitoring of blood glucose (SMBG). Other feasibility and mixed population studies were also reviewed. CGM in T2DM has good feasibility, acceptability, and improved glycaemic control beyond SMBG. There were limited data to draw conclusions on its effect on maternal and fetal outcomes. Conclusion: Further studies of perinatal outcomes in pregnant women with T2DM are required to determine the impact of improved glycaemia with CGM.

Twenty-Four-Hour Ambulatory Blood Pressure Monitoring Parameters During Pregnancy: A Pilot Study.

Introduction: Maternal blood pressure (BP) is a critical cardiovascular marker with profound implications for maternal and fetal well-being, particularly in the detection of hypertensive disorders during pregnancy. Although conventional clinic-based BP (CBP) measurements have traditionvally been used, monitoring 24-hour ambulatory BP (ABP) has emerged as a more reliable method for assessing BP levels and diagnosing conditions such as gestational hypertension and preeclampsia/eclampsia. This study aimed to assess the feasibility and acceptability of 24-hour ABP monitoring in pregnant women and report on various ABP parameters, including ambulatory blood pressure variability (ABPV). Method: A prospective cross-sectional study design was employed, involving 55 multipara pregnant women with and without prior adverse pregnancy outcomes (APOs). The participants underwent baseline assessments, including anthropometrics, resting CBP measurements, and the placement of ABP and actigraphy devices. Following a 24-hour period with these devices, participants shared their experiences to gauge device acceptability. Pregnancy outcomes were collected postpartum. Results: Twenty-four-hour ABP monitoring before 20 weeks of gestation is feasible for women with and without prior APOs. Although some inconvenience was noted, the majority of participants wore the ABP monitoring device for the entire 24-hour period. Pregnant women who later experienced APOs exhibited higher 24-hour ABP and ABPV values in the early stages of pregnancy. Conclusion: The study highlights the potential benefits of 24-hour ABP monitoring as a valuable tool in prenatal care, emphasizing the need for further research in this area.

Labor management and neonatal outcomes in cardiotocography categories II and III (Review).

The safe care of both mothers and fetuses during labor is a primary goal of all health professionals. The assessment of fetal oxygenation and well-being is a key aspect of perinatal care provided. Fetal heart rate (FHR) auscultation became part of daily obstetric practice in a number of countries during the 20th century and remains a key method of fetal monitoring, particularly in low-risk pregnancies. Cardiotocography (CTG) is the continuous monitoring and recording of the FHR and uterine myometrial activity, making it possible to assess the fetal condition. It therefore plays a critical role in the detection of fetal hypoxia during labor, a condition directly related to short- and long-term complications in the newborn. Herein, particular reference is made to the management of CTG category II and III standards, as well as to the handling of childbirth. In addition, specific FHR patterns are associated with immediate neonatal outcomes based on updated studies conducted worldwide. Finally, the prognostic significance of CTG and its potential as a prospective avenue for further investigation are also highlighted herein. Given that the misinterpretation of CTG findings is the most common cause of medical-legal responsibility, this knowledge field requires more emphasis and attention. The aim of the present review was to further deepen the knowledge on issues that mainly concern the safety and monitoring of pregnant women and fetuses during childbirth.

Acceptability of and satisfaction with continuous glucose monitoring in pregnant women with type 2 diabetes mellitus: A service improvement project.

There are limited data regarding intermittently scanned continuous glucose monitoring (isCGM) in pregnancy for women with Type 2 diabetes. We have tested the acceptability and feasibility of an isCGM method using Libre device. In a hospital-based service improvement project, 23 pregnant women (March 2022-April 2023), with Type 2 diabetes got isCGM for monitoring from 20 weeks until delivery. Women completed a structured and validated questionnaire assessing satisfaction, equipment issue, relationship with diabetes team. Two-thirds of the women were satisfied with the convenience and found it reliable. 86% wanted to use it for future pregnancies, and 90% would recommend it to others. Sensor falls off was seen in three obese women and about a tenth felt the reliability was poor in extreme ranges of sugar levels. The relationship with the diabetes team was rated high. isCGM could be a useful and well-received tool for improving glycaemic control in pregnancies with Type 2 diabetes.

Analysis of Qualitative Studies on ANC Services During the Covid 19 Pandemic at PMB Ana Hasanah

Background : In this COVID-19 pandemic situation, there are many restrictions on almost all routine services including maternal and newborn health services. Pregnant women are advised to continue to routinely carry out pregnancy checks during the pandemic even though there are service modifications (social distancing). Purpose of Writing: To obtain in-depth information about ANC services during the Covid-19 pandemic at PMB Ana Hasanah. Research Methods: The research used is a qualitative approach with the type of Rapid Assessment Procedures (RAP) research. The informants of this study consisted of 8 pregnant women who made antenatal care visits at PMB Ana Hasanah. While the key informants were husbands or families of pregnant women and Ana Hasanah PMB officers. Research Results: input components, human resources are sufficient and according to standards. Funds are available and sourced from clinic revenue turnover. SOPs are available which refer to the RI Ministry of Health Guidelines. The facilities and infrastructure are complete. For the process component, midwives' independent practice has carried out the flow of antenatal care services and health protocols according to the guidelines, but level 3 PPE is still limited. For the output component, the scope of ANC services has decreased significantly during the pandemic. For the outcome component, pregnant women are satisfied with antenatal care services, but some pregnant women do not have routine checks. Conclusions and Suggestions: The results of this study are expected to provide information to the Mandiri Midwife Practice as a place for maternal and neonatal health services so that they can provide the best service to pregnant women during the pandemic both online and offline so that monitoring of pregnant women during the COVID-19 pandemic can run well.

Assessment of uptake of intermittent preventive treatment of malaria among pregnant women attending antenatal clinic in public health facilities in Osogbo metropolis, Osun state, Nigeria

BackgroundWHO recommends three or more doses of intermittent preventive treatment of Malaria with Sulfadoxine Pyrimethamine (IPTp-SP) for pregnant women living in areas of moderate-to-high malaria transmission in Africa to protect them and their babies from severe risks by malaria. Despite this, the coverage of utilization of a minimum of three doses of the drug is still very low in Nigeria. This study assessed the knowledge and utilisation of IPTp-SP among pregnant women attending antenatal clinics in public health facilities in Osogbo, Nigeria. MethodsDescriptive cross-sectional was used, data were randomly collected from 549 respondents through a semi-structured self-administered questionnaire. Descriptive statistics, Pearson chi-square, and logistic regression were used for analysis. ResultsAbout half (49.4%) of the respondents had good overall knowledge of IPTp-SP, 72.2% took a minimum of one dose, and only 10.1 % took a minimum of three doses. Factors influencing the utilisation included drug affordability, SP shortage at the facility, and monitoring of pregnant women’s intake of SP. Logistic regression analysis indicated that pregnant women in primary and secondary healthcare settings were 2.4 times and 1.3 times respectively more likely to utilise IPTp than those in tertiary healthcare settings.Conclusion and recommendation.Almost half of the participants had good knowledge of IPTp-SP, only a few took four doses. Healthcare providers should organize IEC programmes to create more awareness among the public on the use and safety of SP in pregnancy. The government is to establish a mechanism to ensure a consistent supply of SP in all healthcare settings,

Outcome findings of COVID-19 vaccine among 31 977 pregnant women in Indonesia.

We provide an overview of the safety of messenger RNA and inactivated coronavirus disease 2019 (COVID-19) vaccine and monitoring of pregnant women after COVID-19 vaccination. The vaccine safety outcome profile is beneficial for further recommendations of COVID-19 vaccination in pregnancy. This research was conducted as descriptive research. Sampling was performed using an online questionnaire to be filled out voluntarily and distributed to all pregnant women in Indonesia who received the COVID-19 vaccination. Data collection was performed and descriptive statistics were obtained. Among 31 977 pregnant women, 24 212 (75.7%) received the first dose, 7619 (23.8%) received the second dose, and 146 (4.5%) received the third dose of the COVID-19 vaccine. Sinovac vaccine is the most administered vaccine to pregnant women (27 122 [84%]). Most pregnant women (78.7%) who were vaccinated had no adverse effects after immunization, while the most reported adverse effects were mild symptoms. The current study contributed evidence that COVID-19 vaccination during pregnancy has minimal adverse effects. These findings may help pregnant women and healthcare providers to make informed decisions regarding vaccination.

A pregnancy-specific Glucose management indicator derived from continuous glucose monitoring in pregnant women with type 1 diabetes.

Glucose management indicator (GMI) is a core metric derived from continuous glucose monitoring (CGM) and is widely used to evaluate glucose control in patients with diabetes. No study has explored the pregnancy-specific GMI. This study aimed to derive a best-fitting model to calculate GMI from mean blood glucose (MBG) obtained from CGM among pregnant women with type 1 diabetes mellitus (T1DM). A total of 272 CGM data and corresponding laboratory HbA1c from 98 pregnant women with T1DM in the CARNATION study were analysed in this study. Continuous glucose monitoring data were collected to calculate MBG, time-in-range (TIR), and glycaemic variability parameters. The relationships between the MBG and HbA1c during pregnancy and postpartum were explored. Mix-effect regression analysis with polynomial terms and cross-validation method was conducted to investigate the best-fitting model to calculate GMI from MBG obtained by CGM. The pregnant women had a mean age of 28.9±3.8years, with a diabetes duration of 8.8±6.2years and a mean body mass index (BMI) of 21.1±2.5kg/m2 . The HbA1c levels were 6.1±1.0% and 6.4±1.0% during pregnancy and at postpartum (p=0.024). The MBG levels were lower during pregnancy than those at postpartum (6.5±1.1mmol/L vs. 7.1±1.5mmol/L, p=0.008). After adjusting the confounders of haemoglobin (Hb), BMI, trimesters, disease duration, mean amplitude of glycaemic excursions and CV%, we developed a pregnancy-specific GMI-MBG equation: GMI for pregnancy (%)=0.84-0.28* [Trimester] + 0.08 * [ BMI in kg/m2 ] + 0.01 * [Hb in g/mL] + 0.50 * [MBG in mmol/L]. We derived a pregnancy-specific GMI equation, which should be recommended for antenatal clinical care. ChiCTR1900025955.

Maternal diet and interactions with nutritional evaluation during pregnancy.

This narrative review aims to describe the knowledge regarding nutritional evaluation and monitoring in pregnant women. We discuss care provided by non-specialists in nutrition, regarding dietary information and risks during pregnancy, from a theoretical or conceptual viewpoint. A narrative review was conducted following a literature search when scientific databases were investigated, including SciELO, LILACS, Medline, PubMed, theses, government reports, books, and chapters in books. Finally, the material was fully read, categorized, and critically analyzed. National and international protocols of prenatal nutritional care were included and discussed. Different protocols describe the complexity of evaluating and monitoring nutrition among pregnant women during the prenatal period according to each country. The understanding of social conditions and eating habits has an important role in providing nutritional advice during pregnancy. The lack of dietitians in care overwhelms the healthcare workers and characterizes a missed opportunity. Therefore, it is important to consider rapid support tools that can track adverse nutritional status, and ways to recommend a diet that meets eating habit dynamics, according to the reality of each public health system.

1200-P: A1C and Neonatal Outcomes Improved with Real-Time Continuous Glucose Monitoring in Pregnant Women with Preexisting Type 2 Diabetes

Preexisting type 2 diabetes (T2D) in pregnancy is increasing and confers significant health risks to the mother and fetus. Continuous glucose monitoring (CGM) systems provide real-time feedback for patients and allow for remote monitoring and therapeutic adjustments. CGM is ideal for pregnancy where insulin requirements and glucose levels are rapidly changing throughout the pregnancy and postpartum. Previous studies have demonstrated improved maternal and neonatal outcomes with the use of CGM in the context of T1D. This study used the Dexcom G6 CGM in pregnant women with preexisting T2D to determine if there is a reduction of A1C and neonatal hypoglycemia compared to preexisting T2D in women using self-monitored blood glucose (SMBG) to manage their diabetes. Women aged 18-40 years with preexisting T2D, using multiple daily insulin injections, and &amp;lt;14 weeks pregnant were enrolled in the study. Participants were randomly assigned to use G6 or SMBG during pregnancy. Mann Whitney U Test, Wilcoxon Signed Rank Test, and Chi-square tests were used to analyze gestational age (GA), A1C at baseline and at 34 weeks, and occurrence of neonatal hypoglycemia. Fourteen participants completed the study. In the G6 group (n=7, median age 28 years, GA 37 weeks), A1c decreased from 7.0% to 6.1% (p=0.045). In the SMBG group (n=7, median age 36 years, GA 38 weeks), A1c decreased from 6.3% to 6.1% (p=NS). There was no significant difference in the GA between the groups. None of the 7 infants in the G6 group had perinatal hypoglycemia compared to 4 out of 7 infants in the SMBG group (p=0.005). This study suggests that use of the DexcomG6 CGM in preexisting T2D during pregnancy can lower A1C and reduce neonatal hypoglycemia. Disclosure G.Nunlee-bland: Research Support; Dexcom, Inc. P.Cofie: None. Funding Dexcom, Inc. (11S-2019-037)

1197-P: A Pregnancy-Specific GMI Derived from Continuous Glucose Monitoring in Pregnant Women with Type 1 Diabetes

Objective: The relationship between glycated hemoglobin (HbA1c) and glucose concentrations was widely explored in patients with diabetes, but all of them excluded pregnancies. The purpose of this study was to derive a best-fitting model to calculate glucose management indicator (GMI) from mean blood glucose (MBG) obtained from continuous glucose monitoring (CGM) among pregnant women with type 1 diabetes mellitus (T1DM). Methods: A total of 272 CGM data and corresponding laboratory HbA1c from 98 pregnant women with T1DM in the CARNATION study were analyzed in this study. CGM data were collected to calculate MBG, time-in-range (TIR), and glycemic variability parameters. The relationships between the MBG and HbA1c during pregnancy, and postpartum were explored. Mix-effect regression analysis with polynomial terms and cross-validation method was conducted to investigate the best-fitting model to calculate GMI from MBG obtained by CGM. Results: The pregnant women had a mean age of 28.91±3.78 years, with a diabetes duration of 8.79±6.18 years and a mean BMI of 21.07±2.48 kg/m2. The HbA1c levels were 6.13±1.02% and 6.41±1.00% during pregnancy and at postpartum (P=0.024). The MBG levels were lower during pregnancy than those at postpartum (6.49±1.11 mmol/L vs 7.11±1.46 mmol/L, P= 0.008). After adjusting the confounders of hemoglobin (Hb), BMI, trimesters, disease duration, MAGE and CV%, we developed a pregnancy-specific GMI-MBG equation: GMI for pregnancy (%) = 0.84-0.28* [Trimester]+0.08 * [ BMI in kg/m2 ] +0.01* [Hb in g/mL]+ 0.50 * [MBG in mmol/L]. Conclusion: We derived a pregnancy-specific GMI-MBG equation, which should be recommended for antenatal clinical care. Disclosure P.Ling: None. J.Yan: None. J.Weng: None. J.Lv: None. D.Yang: None. C.Wang: None. X.Zheng: None. S.Luo: None. X.Yang: None. H.Deng: None. W.Xu: None. Funding Science and Technology Planning Project of Guangzhou (202102010154); Shanghai Medical and Health Development Foundation (DMRFP_II_14); National Natural Science Foundation of China (81941022)

Blood Glucose monitoring in pregnant women with gestational diabetes mellitus

Background: Women with gestational diabetes mellitus (GDM) are more likely to develop pre-eclampsia during pregnancy, and to have the birth induced, suffer trauma to the perineum during birth, or to give birth by caesarean section.Good blood glucose control throughout pregnancy will reduce the risk of fetal macrosomia, trauma during birth (for her and her baby), induction of labor and/or caesarean section, neonatal hypoglycemia, and perinatal death. Monitoring of blood glucose levels is an important way to maintain control of sugar concentrations in the blood.However, it is not clear which is best method or frequency for monitoring blood glucose for limiting health complications for women and their babies.The purpose of this rapid literature review is to identify the most recent evidence and knowledge concerning blood glucose monitoring in pregnant women with gestational diabetes mellitus. Methods: We undertook a Rapid Literature Review focusing on articles published from 2020 to 2022 thus offering the readers access to most up-to-date evidence concerning the topic. We searched the online databases of Pubmed, EMBASE, Cochrane Library, and BMJ from January 2020 till May 15, 2022. Inclusion criteria were studies of blood glucose monitoring for pregnant women with gestational diabetes mellitus. Results: Nine papers were included in the final review. Recent evidence on frequency of blood glucose monitoring, new glucose monitoring technologies, remote monitoring technologies and reminder systems in blood glucose monitoring were summarized. Main Contribution to Evidence-Based Practice: Recommendations for frequency of blood glucose monitoring should be tailored according to pregnant women’s blood glucose management plan. Continuous glucose monitoring (CGM) should be considered for pregnant women under some specific conditions. Remote monitoring technologies or reminder systems based on smartphones, computers and tablets could be considered to improve patient’s compliance toward blood glucose monitoring.

Challenges and Limitation Analysis of an IoT-Dependent System for Deployment in Smart Healthcare Using Communication Standards Features

The use of IoT technology is rapidly increasing in healthcare development and smart healthcare system for fitness programs, monitoring, data analysis, etc. To improve the efficiency of monitoring, various studies have been conducted in this field to achieve improved precision. The architecture proposed herein is based on IoT integrated with a cloud system in which power absorption and accuracy are major concerns. We discuss and analyze development in this domain to improve the performance of IoT systems related to health care. Standards of communication for IoT data transmission and reception can help to understand the exact power absorption in different devices to achieve improved performance for healthcare development. We also systematically analyze the use of IoT in healthcare systems using cloud features, as well as the performance and limitations of IoT in this field. Furthermore, we discuss the design of an IoT system for efficient monitoring of various healthcare issues in elderly people and limitations of an existing system in terms of resources, power absorption and security when implemented in different devices as per requirements. Blood pressure and heartbeat monitoring in pregnant women are examples of high-intensity applications of NB-IoT (narrowband IoT), technology that supports widespread communication with a very low data cost and minimum processing complexity and battery lifespan. This article also focuses on analysis of the performance of narrowband IoT in terms of delay and throughput using single- and multinode approaches. We performed analysis using the message queuing telemetry transport protocol (MQTTP), which was found to be efficient compared to the limited application protocol (LAP) in sending information from sensors.

Remote blood pressure monitoring in high risk pregnancy — study protocol for a randomised controlled trial (REMOTE CONTROL trial)

BackgroundPregnant women at high risk for developing a hypertensive disorder of pregnancy require frequent antenatal assessments, especially of their blood pressure. This expends significant resources for both the patient and healthcare system. An alternative to in-clinic assessments is a remote blood pressure monitoring strategy, in which patients self-record their blood pressure at home using a validated blood pressure machine. This has the potential to be cost-effective, increase patient satisfaction, and reduce outpatient visits, and has had widespread uptake recently given the increased need for remote care during the ongoing COVID-19 pandemic. However robust evidence supporting this approach over a traditional face-to-face approach is lacking, and the impact on maternal and foetal outcomes has not yet been reported. Thus, there is an urgent need to assess the efficacy of remote monitoring in pregnant women at high risk of developing a hypertensive disorder of pregnancy.MethodsThe REMOTE CONTROL trial is a pragmatic, unblinded, randomised controlled trial, which aims to compare remote blood pressure monitoring in high-risk pregnant women with conventional face-to-face clinic monitoring, in a 1:1 allocation ratio. The study will recruit patients across 3 metropolitan Australian teaching hospitals and will evaluate the safety, cost-effectiveness, impact on healthcare utilisation and end-user satisfaction of remote blood pressure monitoring.DiscussionRemote blood pressure monitoring is garnering interest worldwide and has been increasingly implemented following the COVID-19 pandemic. However, robust data regarding its safety for maternofoetal outcomes is lacking. The REMOTE CONTROL trial is amongst the first randomised controlled trials currently underway, powered to evaluate maternal and foetal outcomes. If proven to be as safe as conventional clinic monitoring, major potential benefits include reducing clinic visits, waiting times, travel costs, and improving delivery of care to vulnerable populations in rural and remote communities.Trial registrationThe trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001049965p, on October 11th, 2020).

Adjustment of Maternal Variable Rate Insulin Infusions Using Real-Time Continuous Glucose Monitoring in Pregnant Women with Type 1 Diabetes.

Real-time continuous glucose monitoring (CGM) in hospital holds promise; however, further evidence is required on its use to guide adjustment of variable rate intravenous insulin infusion (VRIII). We retrospectively analyzed data from 20 women with type 1 diabetes during the peripartum period who were commenced on VRIII. Data were analyzed for CGM accuracy (Dexcom G6) using point-of-care glucose-CGM matched pairs. The study was entirely observational, with no deviation from standard clinical care. Twenty women were included; median age 30 (26-35) years with first glycated hemoglobin in pregnancy of 57 (49-60) mmol/mol. Overall median absolute relative difference was 6.1 (1.6-17.3)%. The total simulated CGM-adjusted VRIII was 2.5 U per hour, compared with 2.4 U per hour with capillary blood glucose-adjusted VRIII. In this retrospective analysis of CGM adjustment of maternal VRIII, we demonstrate early feasibility and considerable accuracy. Further prospective studies are required to confirm the safety and potential efficacy of CGM-based insulin titration.

Insulin pump therapy with and without continuous glucose monitoring in pregnant women with type 1 diabetes: a prospective observational Orchestra Foundation study in Poland

AimsThe effects of continuous subcutaneous insulin infusion (CSII) therapy with or without continuous glucose monitoring (CGM) on neonatal outcomes and glycemic outcomes of pregnant women with type 1 diabetes (T1D), living in Poland, were assessed.MethodsThis prospective observational study enrolled women with T1D (N = 481, aged 18–45 years) who were pregnant or planned pregnancy. All used CSII therapy and a subset used CGM with CSII (CSII + CGM). Neonatal outcomes (e.g., rate of large for gestational age [LGA] delivery [birth weight > 90th percentile]) and maternal glycemia (e.g., HbA1c and percentage of time at sensor glucose ranges) were evaluated.ResultsOverall HbA1c at trimesters 1, 2, and 3 was 6.8 ± 1.1% (50.9 ± 12.3 mmol/mol, N = 354), 5.8 ± 0.7% (40.1 ± 8.0 mmol/mol, N = 318), and 5.9 ± 0.7% (41.4 ± 8.0 mmol/mol, N = 255), respectively. A HbA1c target of < 6.0% (42 mmol/mol) at each trimester was achieved by 20.9% (74/354), 65.1% (207/318), and 58.0% (148/255), respectively. For women using CSII + CGM versus CSII only, HbA1c levels at trimesters 1, 2, and 3 were 6.5 ± 0.9% versus 7.1 ± 1.3% (47.8 ± 9.7 mmol/mol versus 54.3 ± 14.0 mmol/mol, p < 0.0001), 5.7 ± 0.6% versus 6.0 ± 0.9% (38.9 ± 6.5 mmol/mol versus 41.6 ± 9.3 mmol/mol, p = 0.0122), and 5.8 ± 0.6% versus 6.1 ± 0.8% (40.3 ± 6.9 mmol/mol versus 42.9 ± 9.1 mmol/mol, p = 0.0117), respectively. For the overall, CSII only, and CSII + CGM groups, rates of LGA delivery were 22.7% (74/326), 24.6% (34/138), and 21.3% (40/188), respectively.ConclusionsObservational assessment of women with T1D using CSII therapy demonstrated low HbA1c throughout pregnancy and low rates of LGA. The addition of CGM to CSII therapy compared to CSII therapy alone was associated with some improved maternal glycemic and neonatal outcomes.Clinicaltrials.gov identifierNCT01779141 (January 2013).