Gestational Diabetes

GDM: Monitoring (2008)

• Intervention
  What is the relationship between blood glucose monitoring and ketone testing in women with GDM?

  • Conclusion

    Sixteen studies were evaluated regarding blood glucose monitoring and ketone testing in pregnant women and in women with gestational diabetes mellitus.   Six studies report that fasting blood glucose monitoring results in improved glucose control and therefore less risk of poor maternal and neonatal outcomes.   Seven studies report a correlation between postprandial blood glucose values with improved maternal and neonatal outcomes; however, ideal postprandial testing timing is unknown.  Two of three studies regarding ketonemia and ketonuria with poor metabolic control during a diabetic pregnancy report a positive association with lower IQ in offspring.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Blood glucose monitoring and ketone testing in women with GDM
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Banerjee S, Ghosh US, Banerjee D.  Foetomaternal complications in pregnancies with diabetes mellitus:  association with the amount of insulin requirement, mean terminal blood glucose and HbA1c levels.  J Indian Med Assoc 2003;101(12):728, 730-2, 740. 
      • Ben-Haroush A, Yogev Y, Chen R, Rosenn B, Hod M, Langer O.  The postprandial glucose profile in the diabetic pregnancy.  Am J Obstet Gynecol 2004;191:576-81.
      • Buhling KJ, Winkel T, Wolf C, Kurzidim B, Mahmoudi M, Wohlfarth K, Wascher C, Schink T, Dudenhausen JW.  Optimal timing for postprandial glucose measurement in pregnant women with diabetes and a non-diabetic pregnant population evaluated by the Continuous Glucose Monitoring System (CGMS).  J Perinat Med 2005;33(2):125-131.
      • Chen R, Yogev Y, Ben-Haroush A, Jovanovic L, Hod M, Phillip M.  Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus.  J Matern Fetal Neonatal Med 2003;14(4):256-60.
      • Churchill JA, Berendes HW, Nemore J.  Neuropsychological deficits in children of diabetic mothers.  Am J Obstet Gynecol 1969; 105:257-268.
      • Combs CA, Gunderson E, Kitzmiller JL, Gavin LA, Main EK.  Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy.  Diabetes Care 1992;15:1251-1257.
      • De Veciana M, Major CA, Morgan MA, Asrat T, Toohey JS, Lien JM, Evans AT.  Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy.  NEJM 1995;333:1237-1241.
      • Homko CJ, Sivan E, Reece EA.  The impact of self-monitoring of blood glucose on self-efficacy and pregnancy outcomes in women with diet-controlled gestational diabetes.  Diabetes Educ 2002;28(3):435-43.
      • Langer O, Levy J, Brustman L, Anyaegbunam A, Merkatz R, Divon M.  Glycemic control in gestational diabetes mellitus - how tight is tight enough:  small for gestational age versus large for gestational age?  Am J Obstet Gynecol 1989;161:646-653.
      • Langer O, Langer N, Piper JM, Elliott B, Anyaegbunam A.  Cultural diversity as a factor in self-monitoring blood glucose in gestational diabetes.  J Assoc Acad Min Phys 1995;6:73-77.
      • Langer O, Mazze RS.  Diabetes in pregnancy:  Evaluating self-monitoring performance and glycemic control with memory-based reflectance meters.  Am J Obstet Gynecol 1986;155:635-7. 
      • Naeye RL, Chez RA.  Effects of maternal acetonuria and low pregnancy weight gain on children's psychomotor development.  Am J Obstet Gynecol 1981;139:189-193. 
      • Parretti E, Mecacci F, Papini M, Cioni R, Carignani L, Mignosa M, La Torre P, Mello G.  Third-trimester maternal glucose levels from diurnal profiles in nondiabetic pregnancies:  correlation with sonographic parameters of fetal growth.  Diabetes Care 2001; 24:1319-1323.
      • Rizzo T, Metzger BE, Burns WJ, Burns K.  Correlations between antepartum maternal metabolism and intelligence of offspring.  NEJM 1991;325(13):911-916. 
      • Sivan E, Weisz B, Homko CJ, Reece EA, Schiff E.  One or two hours postprandial glucose measurements:  Are they the same?  Am J Obstet Gynecol 2001;185:604-7.
      • Weisz B, Shrim A, Homko CJ, Schiff E, Epstein GS, Sivan E.  One hour versus two hours postprandial glucose measurement in gestational diabetes:  a prospective study.  J Perinatol 2005;25(4):241-4.
  • Search Plan and Results: Monitoring 2006