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Self-Monitoring of Blood Glucose: A Complementary Method Beyond the Oral Glucose Tolerance Test to Identify Hyperglycemia During Pregnancy

Published:February 18, 2019DOI:https://doi.org/10.1016/j.jcjd.2019.02.004

      Abstract

      Objectives

      To compare: 1) 75 g oral glucose tolerance test (OGTT) and self-monitoring of blood glucose (SMBG) in identifying gestational diabetes mellitus (GDM) and other hyperglycemic statuses in pregnant women; 2) pregnancy outcomes according to glycemic status; and 3) participants’ opinions regarding both methods.

      Methods

      A prospective study in women with a 50 g glucose load test ≥7.2 mmol/L at 24 to 28 weeks’ gestation and singleton pregnancy. Women underwent OGTT (blinded) at day 1, followed by 7 days of SMBG (4 daily measurements: fasting and 2 h postprandially) without modifying diet or lifestyle. GDM (OGTT+) was diagnosed using the criteria of the International Association of the Diabetes and Pregnancy Study Groups, while pregnancy hyperglycemia (SMBG+) was defined as ≥4/7 glucose values ≥5.3 after fasting or ≥6.7 mmol/L 2 h postprandially for any meal of the day. Equivalent management was provided to women with GDM and/or pregnancy-related hyperglycemia.

      Results

      We divided 103 participants (age: 29.5±5.0 years; prepregnancy body mass index: 25.3±5.4 kg/m2) into 4 groups according to test results: OGTT+/SMBG+ (n=12, 11.7%); OGTT+/SMBG– (n=14, 13.6%); OGTT–/SMBG+ (n=9, 8.7%); and OGTT–/SMBG– (n=68, 66.0%). Clinical characteristics and maternal outcomes were statistically similar between groups. Neonatal complication rates were greater in groups with hyperglycemia than in the OGTT–/SMBG– group, notably neonatal hypoglycemia (9/12, 7/14, 5/9 vs. 6/68; p<0.001). Participants reported no convenience difference between methods but would prefer OGTT for a future pregnancy.

      Conclusions

      More than half of the women with OGTT+ were normoglycemic in daily life. Conversely, 11.7% of women with OGTT– had pregnancy hyperglycemia. OGTT+ and/or SMBG+ were equally associated with greater neonatal complications. This study suggests that alongside OGTT, SMBG could improve the care of pregnant women.

      Résumé

      Objectifs

      Comparer: 1) le test d’hyperglycémie provoquée par voie orale (HGPO) avec 75 g de glucose et une autosurveillance de la glycémie (ASG) dans l'identification du diabète gestationnel (DG) et d'autres états hyperglycémiques chez la femme enceinte; 2) les issues de grossesse en fonction de l'état glycémique; et 3) l’opinion des participantes concernant les deux méthodes.

      Méthodes

      Une étude prospective chez des femmes présentant une épreuve de charge en glucose de 50 g ≥ 7,2 mmol/L entre 24 et 28 semaines de gestation et une grossesse unique. Les femmes ont subi une HGPO (résultats en aveugle) au jour 1, suivie de 7 jours d’ASG (4 mesures quotidiennes: à jeun et 2 h après les repas) sans modifier leur régime alimentaire ni leur mode de vie. Le DG (HGPO+) a été diagnostiqué selon les critères de l’Association Internationale des Groupes d’Etude sur le Diabète et la Grossesse, tandis que l’hyperglycémie de grossesse (ASG+) était définie par ≥4/7 valeurs de glucose ≥5,3 à jeun ou ≥ 6,7 mmol/L 2 h après les repas pour tout repas de la journée. Une prise en charge équivalente a été fournie aux femmes atteintes de DG et/ou d'hyperglycémie liée à la grossesse.

      Résultats

      Nous avons réparti 103 participantes (âge: 29,5±5,0 ans; indice de masse corporelle avant la grossesse: 25,3±5,4 kg/m2) en 4 groupes selon les résultats des tests: HGPO+/ASG+ (n=12, 11,7%); HGPO+/ASG– (n=14, 13,6%); HGPO–/ASG+ (n=9, 8,7%); et HGPO–/ASG– (n=68, 66,0%). Les caractéristiques cliniques et les issues maternelles étaient statistiquement similaires entre les groupes. Les taux de complications néonatales étaient plus élevés dans les groupes avec hyperglycémie que dans le groupe HGPO–/ASG–, notamment l'hypoglycémie néonatale (9/12, 7/14, 5/9 contre 6/68, p<0,001). Les participantes n'ont signalé aucune différence de commodité entre les méthodes, mais préféreraient l’HGPO pour une future grossesse.

      Conclusions

      Plus de la moitié des femmes avec HGPO+ étaient normoglycémiques dans la vie quotidienne. À l’inverse, 11,7% des femmes avec HGPO– présentaient une hyperglycémie de grossesse. L’HGPO+ et/ou l’ASG+ étaient également associées à de plus grandes complications néonatales. Cette étude suggère que, parallèlement à l’HGPO, l’ASG pourrait améliorer les soins prodigués aux femmes enceintes.

      Keywords

      Mots Clés

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