Self-monitoring of blood glucose during pregnancy: indications and limitations

Perinatal morbidity and mortality rates, often affected by maternal diabetes, have dramatically been reduced since the discovery of insulin and its therapeutic implementation. In addition to increased availability of insulin, many important technological advances have been developed over the preceding decades. These advances culminated in a larger array of diagnostic and therapeutic capabilities that contributed to improved outcomes in high-risk pregnancies.The availability of glucose meters has represented an important positive impact in the treatment of pregnant women with any type of diabetes. Data frequently show patients who perform self-monitoring of blood glucose (SMBG) more strictly adhere to treatment programs due to increased comprehension regarding treatment and participation in the prescribed treatment regimen [1].SMBG is an integral part of standard diabetes care [2]. It allows pregnant women and their healthcare providers to determine the most effective therapeutic modality (e.g. diet, physical activity, or insulin) to control glucose levels and reduce risks of diabetes-related complications. The number of daily tests required to adequately monitor blood glucose levels is specific to the patient and based on the recommendation of the practitioner [3]. Several characteristics, unique to each pregnant woman should be considered. For example, the type of treatment (diet and/or insulin), frequency and intensity of physical activity, and the risk of hypoglycemia. Additionally, SMBG makes patients feel more secure and comfortable using insulin since it allows early recognition of symptoms of hypoglycemia [4].The indications for, and frequency of SMBG in pregnant women that are not under insulin treatment must be tailored to the individual. Patients must be trained to adjust the amount of food intake with the frequency, intensity, and timing of physical exercise. It is unclear whether SMBG alone leads to improved glycemic control in non-insulin treated subjec