Monitoring the glycaemic profile during pregnancy for women with pre-existing diabetes

Intensive blood glucose concentration monitoring assists women with diabetes to achieve glycaemic targets (see Glycaemic targets during pregnancy for women with pre-existing diabetes). Ideally, this should start before pregnancy or, at the latest, as soon as pregnancy is recognised. Recording of dietary information can also help women and their healthcare providers to guide management decisions.

During pregnancy, all women with type 2 diabetes should measure their blood glucose concentrations routinely before and after each main meal.

Women with type 1 diabetes should continue intensive blood glucose concentration monitoring, as in the pre-conception period (ie before and after each meal, and before bedtime).

When used in combination with capillary (finger-prick) blood glucose concentration monitoring, continuous glucose monitoring or flash glucose monitoring can help guide treatment of women with pre-existing diabetes during pregnancy, particularly those treated with insulin. Continuous glucose monitoring (CGM) during pregnancy in patients with type 1 diabetes has been associated with an improved glycaemic profile and improved neonatal outcomes. However, the cost of continuous glucose monitoring and flash glucose monitoring may be a barrier, unless subsidised. At the time of writing, the Australian Government subsidises continuous and flash glucose monitoring on the National Diabetes Services Scheme (NDSS) for women with type 1 diabetes who are actively planning pregnancy, pregnant or immediately post-pregnancy. For more information about continuous and flash glucose monitoring, see Interstitial fluid glucose monitoring systems.

Glycated haemoglobin (HbA1c) should be measured every 6 to 8 weeks during pregnancy in women with pre-existing diabetes.