Pregnant? Test yourself daily

Daily self-monitoring of blood sugar, or blood "glucose," levels by pregnant women who have mild gestational diabetes is more effective than weekly office-based testing in reducing the risk of having an infant born with macrosomia, excessively large size for his or her duration of development, according to research published in the current issue of Obstetrics & Gynecology.

Gestational diabetes is a complication of pregnancy in which women develop diabetes, which can be mild or severe and result in adverse effects for both mother and child, especially if it is uncontrolled. Many of cases resolve after delivery, but the condition does put the women at increased risk of diabetes later in life.

The value of this strategy among women with gestational diabetes that requires insulin treatment has been established. "However, the use of blood glucose self-monitoring devices in the management of women with diet-treated gestational diabetes remains controversial," explain Dr. J. Seth Hawkins and co-researchers at the University of Texas Southwestern Medical Center in Dallas. Hawkins is currently based at the University of California Irvine in South Orange.

To further investigate, the team compared birth weights before and after four-times daily self-monitoring or hospital-based monitoring was performed at a Dallas hospital. Between 1991 and 1997, a total of 675 women with diet-treated gestational diabetes underwent glucose monitoring during each office visit at 1- to 2-week intervals. Between 1998 and 2001, another 315 women, also with diet-treated gestational diabetes, were given blood glucose meters and instructed to test themselves four times a day before meals.

The incidence of macrosomia, defined as a birth weight greater than 4,000 grams (8.82 pounds), was significantly higher with weekly monitoring than with daily monitoring (29.5 percent vs 21.9 percent), as was the incidence of large-for-gestational-age offspring (34.4 percent vs 23.1).

The difference was still statistically significant after controlling for maternal demographics and gestational age at diagnosis.

The authors note that maternal weight gain was also reduced after self-monitoring was introduced, although blood glucose levels were not controlled any better.

Hawkins' group concludes that if women with diet-treated gestational diabetes become more involved in glycemic self-monitoring and receive frequent feedback on the effect of diet choices, they will gain less weight and their infants have a lower risk of being born with macrosomia.
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