Application of continuous glucose monitoring and automated insulin delivery technologies for pregnant women with type 1, type 2, or gestational diabetes: an international consensus statement.

Abstract

Insulin resistance increases after the first trimester of pregnancy, leading to glycaemic challenges for women with pregestational type 1 diabetes or type 2 diabetes. Additionally, insulin resistance can promote hyperglycaemia in pregnant women without type 1 diabetes or type 2 diabetes, who develop gestational diabetes. Although most (>95%) women with diabetes deliver healthy babies, maternal dysglycaemia can have consequences for the mother and child, including prenatal, perinatal, immediate, and long-term postnatal complications. Diabetes technologies, such as continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems can aid in optimising glycaemia outside of pregnancy. These novel technologies have not been extensively tested in large randomised controlled trials before and during pregnancy. However, compelling data report the benefits of CGM in type 1 diabetes, and increasing data report on AID systems in pregnancies complicated by type 1 diabetes. Appropriate CGM glucose thresholds for the diagnosis of gestational diabetes and the recommended time in range treatment targets for the routine management of gestational diabetes and type 2 diabetes still need to be determined. The recommendations in this Consensus Statement emphasise the value of CGM during preconception and pregnancy for women with pregestational type 1 diabetes in reducing pregnancy complications. Recommendations also include the use of AID systems in women with pregestational type 1 diabetes to improve glycaemic management during preconception, during pregnancy and delivery, and in the postpartum period. This Consensus Statement has been endorsed by 24 societies and groups.