Technology and pregnancy: how far have we come and where are we headed?

Abstract

Professionals currently working in the field of pregnancy and diabetes mellitus (DM) are witnessing the rapid evolution of DM treatment technology applied to this setting. This is corroborated by women who have had pregnancies using different technologies.

A prime example is the CONCEPTT study, which in 2017 demonstrated that the use of continuous glucose monitoring (CGM) in pregnant women with type 1 DM improved both glycemic control and clinical outcomes. More recently, clinical trials with closed-loop systems have also been published, demonstrating improved glycemic control, with the INR being accepted as a surrogate endpoint for actual pregnancy outcomes. The first of these clinical trials to be published was AIDAPT2, followed by the CRISTAL and CIRCUIT studies.

In women with type 2 DM, it seems intuitive that the use of CGM should also be beneficial, and in several countries its use is publicly funded, especially for women on multiple daily insulin injections. However, to date, and pending the results of randomized clinical trials, evidence of the benefits of CGM in this context is limited compared to that available in women with type 1 diabetes. There are no data on the use of closed-loop systems in this population.

In women with gestational diabetes, several clinical trials have been conducted testing the use of CGM, and the results are inconsistent. Thus, the DIPGLUMO4 study observed an improvement in IRR, but without net clinical benefits; GRACE also observed an improvement in IRR with a reduction in large-for-gestational-age infants and a trend toward more small infants; while The Steady Sugar trial and the Zorzo study did not observe glycemic improvements, but did show improvements in several clinical outcomes. In all the studies that evaluated it, women indicated their preference for CGM.

Finally, it is important to remember that even in scenarios where the benefit is most evident, such as in women with type 1 diabetes, obstetric and perinatal outcomes remain far from those observed in the general population, indicating that there is still considerable room for improvement.