Autosurveillance glycémique et diabète : le cas particulier de la femme enceinte

Diabetes throughout gestation presents challenge that greatly influences maternal and fetal outcomes. Since the degree of maternal hyperglycemia is the higher determinant of these risks, glucose monitoring has become a fundamental tool in the management. A pregnancy affected by diabetes is associated with macrosomia, fetal malformations, spontaneous preterm delivery, and labor complications. These risks can be minimized by tight glycemic control through diet, insulin, and attentive monitoring of blood glucose levels. Maintaining glycemic control is important during the pregnancy but also during labor and delivery. The risk of diabetes-related complications in pregnancy is more strongly associated with postprandial glucose concentrations than with fasting plasma glucose levels. Self-monitoring of blood glucose (SMBG) strategies that incorporate postprandial glucose testing provides better glycemic control and greater reductions in risk of complications than preprandial glucose testing alone. Although the optimal timing and frequency of SMBG remain controversial, available clinical evidence supports testing 4 times per day in women with gestational diabetes managed by medical nutrition therapy only and 6 times per day in pregnant women treated with insulin. Although most pregnant diabetic women currently monitor their diabetes using SMBG, it is possible that the new technologies as the continuous glucose monitoring (CGM) will offer a myriad of benefits.