3.3.0.0 Glu­cose Mon­i­tor­ing

Reflect­ing this phys­i­ol­o­gy, fast­ing and post­pran­di­al mon­i­tor­ing of blood glu­cose is rec­om­mend­ed to achieve metabol­ic con­trol in preg­nant women with di­a­betes. Prepran­di­al test­ing is also rec­om­mend­ed for women with pre­ex­ist­ing di­a­betes using in­sulin pumps or basal-‍bolus ther­apy, so that pre­meal rap­i­dact­ing in­sulin dosage can be ad­just­ed. Post­pran­di­al mon­i­tor­ing is as­so­ci­at­ed with bet­ter glycemic con­trol and lower risk of preeclamp­sia (19-21). There are no ad­e­quate­ly pow­ered ran­dom­ized tri­als com­par­ing dif­fer­ent fast­ing and post­meal glycemic tar­gets in di­a­betes in preg­nan­cy.

Sim­i­lar to the tar­gets rec­om­mend­ed by the Amer­i­can Col­lege of Ob­ste­tri­cians and Gy­ne­col­o­gists (the same as for GDM; de­scribed below) (22), the ADA-‍rec­om­mend­ed tar­gets for women with type 1 or type 2 di­a­betes are as fol­lows:

• Fast­ing <95 mg/dL (5.3 mmol/‍L) and ei­ther

• One-‍hour post­pran­di­al <140 mg/dL (7.8 mmol/‍L) or

• Two-‍hour post­pran­di­al <120 mg/dL (6.7 mmol/‍L)

These val­ues rep­re­sent op­ti­mal con­trol if they can be achieved safe­ly. In prac­tice, it may be chal­leng­ing for women with type 1 di­a­betes to achieve these tar­gets with­out hy­po­glycemia, par­tic­u­larly women with a his­to­ry of recur­rent hy­po­glycemia or hy­po­glycemia un­aware­ness.

If women can­not achieve these tar­gets with­out significant hy­po­glycemia, the ADA sug­gests less strin­gent tar­gets based on clin­i­cal ex­pe­ri­ence and in­di­vid­u­al­iza­tion of care.