Techniques of monitoring blood glucose during pregnancy for women with pre‐existing diabetes

Foong Ming Moy; Amita Ray; Brian S Buckley; Helen M West

doi:10.1002/14651858.CD009613.pub3

Cochrane Database of Systematic Reviews

Techniques of monitoring blood glucose during pregnancy for women with pre‐existing diabetes

Información

DOI:

https://doi.org/10.1002/14651858.CD009613.pub3 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

11 junio 2017see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Embarazo y parto

Copyright:

Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Foong Ming Moy

Correspondencia a: Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

[email protected]

[email protected]
Amita Ray

Department of Obstetrics and Gynaecology, DM Wayanad Institute of Medical Sciences, Wayanad, India
Brian S Buckley

Department of Surgery, University of Phillipines, Manila, Philippines
Helen M West

Institute of Psychology, Health and Society, The University of Liverpool, Liverpool, UK

Contributions of authors

Foong Ming Moy (FMM), the contact person, is the guarantor of the review. Three review authors (FMM, Amita Ray and Brian S Buckely) provided co‐ordination, methodological perspective, clinical perspective and policy perspective of the review. Three authors contributed to developing and writing the review, and commented on drafts of the review update. Helen West drafted the review update, extracted additional data, assessed study quality, undertook data entry and analysis in Review Manager, and prepared 'Summary of findings' tables.

Sources of support

Internal sources

University of Malaya, Malaysia.
(HW) Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK.

External sources

High Impact Research Grant (E000010‐20001), Malaysia.

Funding in providing the Cochrane Library data base and support in retrieving full text articles
(HW) NIHR Cochrane Programme Grant Project: 13/89/05 – Pregnancy and childbirth systematic reviews to support clinical guidelines, UK.

Declarations of interest

Foong Ming Moy: none declared.

Amita Ray: none declared.

Brian Buckley: none declared.

Helen West: was paid to work on Cochrane reviews by a grant to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Acknowledgements

We would like to thank Dr Prathap Tharyan's motivation and assistance in the completion of the previous version of this review.

Helen West's contribution to this project was supported by the National Institute for Health Research, via Cochrane Programme Grant funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

For this update, we used the Cochrane Pregnancy and Childbirth core outcome set for reviews of diabetes in pregnancy, developed by the Cochrane Pregnancy and Childbirth Australasian satellite.

Version history

Published

Title

Stage

Authors

Version

2019 May 23

Techniques of monitoring blood glucose during pregnancy for women with pre‐existing diabetes

Review

Leanne V Jones, Amita Ray, Foong Ming Moy, Brian S Buckley

https://doi.org/10.1002/14651858.CD009613.pub4

2017 Jun 11

Techniques of monitoring blood glucose during pregnancy for women with pre‐existing diabetes

Review

Foong Ming Moy, Amita Ray, Brian S Buckley, Helen M West

https://doi.org/10.1002/14651858.CD009613.pub3

2014 Apr 30

Techniques of monitoring blood glucose during pregnancy for women with pre‐existing diabetes

Review

Foong Ming Moy, Amita Ray, Brian S Buckley

https://doi.org/10.1002/14651858.CD009613.pub2

2012 Feb 15

Techniques of monitoring blood glucose during pregnancy for women with pre‐existing diabetes

Protocol

Foong Ming Moy, Amita Ray, Brian S Buckley

https://doi.org/10.1002/14651858.CD009613

Differences between protocol and review

1. For this update, in order to improve consistency across reviews, we have used the Cochrane Pregnancy and Childbirth core outcome set for reviews of diabetes in pregnancy, developed by the Cochrane Pregnancy and Childbirth Australasian satellite.

The outcomes specified in the last version of the review have been expanded to incorporate the core outcome set, but were as follows.

Primary outcomes

Maternal

Glycaemic control (HbA1c, fructosamine, fasting blood glucose, post‐prandial blood glucose)

Infant

Birthweight
Macrosomia greater than 4.5 kg

Secondary outcomes

Maternal

Frequency of hypoglycaemia
Antenatal hospital stay (percentage requiring admission, length of stay)
Induction of labour
Caesarean section rates
Miscarriage

Infant

Gestational age (at birth) or preterm birth less than 37/less than 34 weeks
Frequency of neonatal hypoglycaemia
Shoulder dystocia
Major and minor anomalies
Neonatal intensive care admissions
Death of baby including stillbirth/neonatal death

to the following.

2. The following outcomes were not pre‐specified.

Birth trauma (shoulder dystocia, bone fracture, nerve palsy) (not pre‐specified as a composite)
Neonatal glucose at age one hour
Transient tachypnoea
Diabetic ketoacidosis
Feeding difficulties

3. We have added 'Summary of findings' tables and an assessment of the quality of the evidence using the GRADE approach.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adult; Female; Humans; Infant, Newborn; Pregnancy;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Study flow diagram.

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Figure 2

Study flow diagram 2016

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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Figure 4

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Analysis 1.1

Comparison 1 Self‐monitoring versus standard care, Outcome 1 Caesarean section.

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Analysis 1.2

Comparison 1 Self‐monitoring versus standard care, Outcome 2 Perinatal mortality.

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Analysis 1.3

Comparison 1 Self‐monitoring versus standard care, Outcome 3 Neonatal mortality and morbidity composite.

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Analysis 1.4

Comparison 1 Self‐monitoring versus standard care, Outcome 4 Glycaemic control during/end of treatment (maternal post‐prandial blood glucose).

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Analysis 1.5

Comparison 1 Self‐monitoring versus standard care, Outcome 5 Glycaemic control during/end of treatment (maternal HbA1c).

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Analysis 1.6

Comparison 1 Self‐monitoring versus standard care, Outcome 6 Miscarriage.

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Analysis 1.7

Comparison 1 Self‐monitoring versus standard care, Outcome 7 Neonatal mortality.

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Analysis 1.8

Comparison 1 Self‐monitoring versus standard care, Outcome 8 Gestational age at birth.

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Analysis 1.9

Comparison 1 Self‐monitoring versus standard care, Outcome 9 Birthweight.

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Analysis 1.10

Comparison 1 Self‐monitoring versus standard care, Outcome 10 Respiratory distress syndrome.

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Analysis 1.11

Comparison 1 Self‐monitoring versus standard care, Outcome 11 Neonatal hypoglycaemia.

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Analysis 1.12

Comparison 1 Self‐monitoring versus standard care, Outcome 12 Neonatal jaundice (hyperbilirubinaemia).

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Analysis 1.13

Comparison 1 Self‐monitoring versus standard care, Outcome 13 Neonatal hypocalcaemia.

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Analysis 1.14

Comparison 1 Self‐monitoring versus standard care, Outcome 14 Neonatal polycythaemia.

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Analysis 1.15

Comparison 1 Self‐monitoring versus standard care, Outcome 15 Neonatal cord vein C‐peptide.

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Analysis 2.1

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 1 Pre‐eclampsia.

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Analysis 2.2

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 2 Hypertension in pregnancy.

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Analysis 2.3

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 3 Caesarean section.

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Analysis 2.4

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 4 Perinatal mortality.

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Analysis 2.5

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 5 Placental abruption.

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Analysis 2.6

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 6 Preterm birth < 37 weeks.

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Analysis 2.7

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 7 Respiratory distress syndrome.

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Analysis 2.8

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 8 Neonatal hypoglycaemia.

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Analysis 2.9

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 9 Neonatal jaundice (hyperbilirubinaemia).

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Analysis 2.10

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 10 Major anomalies.

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Analysis 2.11

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 11 Antenatal hospital admission.

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Analysis 2.12

Comparison 2 Self‐monitoring versus hospitalisation, Outcome 12 Feeding difficulties (not pre‐specified).

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Analysis 3.1

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 1 Pre‐eclampsia.

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Analysis 3.2

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 2 Caesarean section.

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Analysis 3.3

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 3 Large‐for‐gestational age.

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Analysis 3.4

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 4 Perinatal mortality.

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Analysis 3.5

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 5 Weight gain during pregnancy.

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Analysis 3.6

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 6 Insulin dose.

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Analysis 3.7

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 7 Glycaemic control ‐ Insulin dose.

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Analysis 3.8

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 8 Glycaemic control ‐ HbA1c.

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Analysis 3.9

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 9 Stillbirth.

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Analysis 3.10

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 10 Gestational age at birth.

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Analysis 3.11

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 11 Preterm birth < 37 weeks.

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Analysis 3.12

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 12 Macrosomia.

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Analysis 3.13

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 13 Birthweight.

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Analysis 3.14

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 14 Adiposity ‐ Subscapula skinfold thickness.

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Analysis 3.15

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 15 Adiposity ‐ Triceps skinfold thickness.

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$Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 16 Birth trauma (shoulder dystocia, bone fracture, nerve palsy) (not pre‐specified as a composite).$

Analysis 3.16

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 16 Birth trauma (shoulder dystocia, bone fracture, nerve palsy) (not pre‐specified as a composite).

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Analysis 3.17

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 17 Respiratory distress syndrome.

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Analysis 3.18

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 18 Neonatal hypoglycaemia.

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Analysis 3.19

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 19 Neonatal jaundice (hyperbilirubinaemia).

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Analysis 3.20

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 20 Cord IGF‐1.

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Analysis 3.21

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 21 Neonatal glucose at age 1 hour (not pre‐specified).

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Analysis 3.22

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 22 Transient tachypnea (not pre‐specified).

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Analysis 3.23

Comparison 3 Pre‐prandial versus post‐prandial glucose monitoring, Outcome 23 Neonatal intensive care admissions.

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Analysis 4.1

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 1 Caesarean section.

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Analysis 4.2

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 2 Neonatal morbidity composite.

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Analysis 4.3

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 3 Weight gain during pregnancy [kg].

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Analysis 4.4

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 4 Use of additional insulin therapy.

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Analysis 4.5

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 5 Insulin requirement at end of study.

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Analysis 4.6

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 6 Glycaemic control ‐ Maternal fasting blood glucose: before breakfast.

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Analysis 4.7

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 7 Glycaemic control ‐ Maternal fasting blood glucose: before lunch.

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Analysis 4.8

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 8 Glycaemic control ‐ Maternal HbA1c.

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Analysis 4.9

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 9 Glycaemic control ‐ Maternal post‐prandial blood glucose.

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Analysis 4.10

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 10 Gestational age at birth.

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Analysis 4.11

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 11 Macrosomia.

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Analysis 4.12

Comparison 4 Automated telemedicine monitoring versus conventional, Outcome 12 Birthweight.

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Analysis 5.1

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 1 Pre‐eclampsia.

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Analysis 5.2

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 2 Caesarean section.

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Analysis 5.3

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 3 Large‐for‐gestational age.

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Analysis 5.4

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 4 Perinatal mortality.

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Analysis 5.5

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 5 Glycaemic control ‐ Maternal HbA1c.

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Analysis 5.6

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 6 Miscarriage.

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Analysis 5.7

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 7 Neonatal mortality.

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Analysis 5.8

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 8 Gestational age at birth.

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Analysis 5.9

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 9 Preterm birth < 37 weeks.

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Analysis 5.10

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 10 Small‐for‐gestational age.

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Analysis 5.11

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 11 Birthweight.

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Analysis 5.12

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 12 Neonatal hypoglycaemia.

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Analysis 5.13

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 13 Major anomalies.

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Analysis 5.14

Comparison 5 Continuous glucose monitoring versus intermittent glucose monitoring, Outcome 14 Neonatal intensive care unit admissions.

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Analysis 6.1

Comparison 6 Constant CGM versus intermittent CGM, Outcome 1 Caesarean section.

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Analysis 6.2

Comparison 6 Constant CGM versus intermittent CGM, Outcome 2 Weight gain during pregnancy.

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Analysis 6.3

Comparison 6 Constant CGM versus intermittent CGM, Outcome 3 Insulin dosage, 3^rd trimester (IU/kg/day).

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Analysis 6.4

Comparison 6 Constant CGM versus intermittent CGM, Outcome 4 Glycaemic control ‐ Maternal blood glucose (1st trimester).

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Analysis 6.5

Comparison 6 Constant CGM versus intermittent CGM, Outcome 5 Glycaemic control ‐ Maternal blood glucose (3rd trimester).

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Analysis 6.6

Comparison 6 Constant CGM versus intermittent CGM, Outcome 6 Glycaemic control ‐ Maternal HbA1c (1st trimester).

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Analysis 6.7

Comparison 6 Constant CGM versus intermittent CGM, Outcome 7 Glycaemic control ‐ Maternal HbA1c (3rd trimester).

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Analysis 6.8

Comparison 6 Constant CGM versus intermittent CGM, Outcome 8 Maternal hypoglycemia.

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Analysis 6.9

Comparison 6 Constant CGM versus intermittent CGM, Outcome 9 Diabetic ketoacidosis (not pre‐specified).

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Analysis 6.10

Comparison 6 Constant CGM versus intermittent CGM, Outcome 10 Preterm birth < 37 weeks.

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Analysis 6.11

Comparison 6 Constant CGM versus intermittent CGM, Outcome 11 Macrosomia.

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Analysis 6.12

Comparison 6 Constant CGM versus intermittent CGM, Outcome 12 Neonatal hypoglycaemia.

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Summary of findings for the main comparison. Self‐monitoring compared to standard care for women with pre‐existing diabetes

Self‐monitoring compared to standard care for women with pre‐existing diabetes
Patient or population: women with pre‐existing diabetes Setting: one study in the USA Intervention: self‐monitoring Comparison: standard care
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with standard care	Risk with self‐monitoring
Hypertensive disorders of pregnancy: pre‐eclampsia	Study population			(0 studies)		The included study did not report this outcome.

Hypertensive disorders of pregnancy: gestational hypertension	Study population			(0 studies)		The included study did not report this outcome.

Caesarean section	Study population		RR 0.78 (0.40 to 1.49)	28 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	643 per 1000	501 per 1000 (257 to 958)
Glycaemic control during/end of treatment: Maternal HbA1c (%)	The mean maternal HbA1c was 7.2%	The mean maternal HbA1c with self‐monitoring was 0.10 lower (1.93 lower to 1.73 higher)		28 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 3}
Glycaemic control during/end of treatment: Maternal post‐prandial blood glucose (mmmol/L)	The mean maternal post‐prandial blood glucose was 5.3 mmol/L	MD 0.70 lower (2.15 lower to 0.75 higher)		13 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 3}
Large‐for‐gestational age	Study population			(0 studies)		The included study did not report this outcome.

Perinatal mortality	Study population		RR 3.00 (0.13 to 67.91)	28 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}	There were no events in the standard care group and so anticipated absolute effects could not be calculated.
	0 per 1000	0 per 1000 (0 to 0)
Preterm birth less than 37 weeks' gestation	Study population			(0 studies)		The included study did not report this outcome.

Preterm birth less than 34 weeks' gestation	Study population			(0 studies)		The included study did not report this outcome.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ One study with design limitations. ² Wide CI crossing the line of no effect, few events and small sample size. ³ Wide CI crossing the line of no effect, and small sample size.

Summary of findings for the main comparison. Self‐monitoring compared to standard care for women with pre‐existing diabetes

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Summary of findings 2. Self‐monitoring compared to hospitalisation for women with pre‐existing diabetes

Self‐monitoring compared to hospitalisation for women with pre‐existing diabetes
Patient or population: women with pre‐existing diabetes Setting: one study in Sweden Intervention: Self‐monitoring Comparison: hospitalisation
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with hospitalisation	Risk with self‐monitoring
Hypertensive disorders of pregnancy: pre‐eclampsia	Study population		RR 4.26 (0.52 to 35.16)	100 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	22 per 1000	93 per 1000 (11 to 764)
Hypertensive disorders of pregnancy: hypertension in pregnancy	Study population		RR 0.43 (0.08 to 2.22)	100 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	87 per 1000	37 per 1000 (7 to 193)
Caesarean section	Study population		RR 0.96 (0.65 to 1.44)	100 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	500 per 1000	480 per 1000 (325 to 720)
Glycaemic control during/end of treatment: maternal HbA1c				(0 studies)		The included study did not report this outcome.
Glycaemic control during/end of treatment: maternal post‐prandial blood glucose				(0 studies)		The included study did not report this outcome.
Large‐for‐gestational age	Study population			(0 studies)		The included study did not report this outcome.

Perinatal mortality	Study population		RR 0.85 (0.05 to 13.24)	100 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	22 per 1000	18 per 1000 (1 to 288)
Preterm birth less than 37 weeks' gestation	Study population		RR 0.85 (0.45 to 1.60)	100 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	304 per 1000	259 per 1000 (137 to 487)
Preterm birth less than 34 weeks' gestation	Study population			(0 studies)		The included study did not report this outcome.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ One study with design limitations. ² Wide CI crossing the line of no effect, few events and small sample size.

Summary of findings 2. Self‐monitoring compared to hospitalisation for women with pre‐existing diabetes

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Summary of findings 3. Pre‐prandial compared to post‐prandial glucose monitoring for women with pre‐existing diabetes

Pre‐prandial compared to post‐prandial glucose monitoring for women with pre‐existing diabetes
Patient or population: women with pre‐existing diabetes Setting: one study in the UK Intervention: pre‐prandial Comparison: post‐prandial glucose monitoring
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with post‐prandial glucose monitoring	Risk with pre‐prandial
Hypertensive disorders of pregnancy: pre‐eclampsia	Study population		RR 6.43 (0.82 to 50.11)	58 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	33 per 1000	214 per 1000 (27 to 1000)
Hypertensive disorders of pregnancy: gestational hypertension	Study population			(0 studies)		The included study did not report this outcome.

Caesarean section	Study population		RR 1.45 (0.92 to 2.28)	61 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	467 per 1000	677 per 1000 (429 to 1000)
Glycaemic control during/end of treatment: HbA1c (%)	The mean hbA1c was 6%	The mean maternal HbA1c with pre‐prandial monitoring as 0.30 higher (0.08 lower to 0.68 higher)		61 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 3}
Glycaemic control during/end of treatment: post‐prandial blood glucose				(0 studies)		The included study did not report this outcome.
Large‐for‐gestational age	Study population		RR 1.16 (0.73 to 1.85)	61 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	500 per 1000	580 per 1000 (365 to 925)
Perinatal mortality	Study population		RR 2.91 (0.12 to 68.66)	61 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}	There were no events in the standard care group and so anticipated absolute effects could not be calculated.
	0 per 1000	0 per 1000 (0 to 0)
Preterm birth less than 37 weeks	Study population		RR 1.33 (0.62 to 2.84)	61 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	267 per 1000	355 per 1000 (165 to 757)
Preterm birth less than 34 weeks' gestation	Study population			(0 studies)		The included study did not report this outcome.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ One study with design limitations. ² Wide CI crossing the line of no effect, few events and small sample size. ³ Wide CI crossing the line of no effect, and small sample size.

Summary of findings 3. Pre‐prandial compared to post‐prandial glucose monitoring for women with pre‐existing diabetes

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Summary of findings 4. Automated telemedicine monitoring compared to conventional for women with pre‐existing diabetes

Automated telemedicine monitoring compared to conventional for women with pre‐existing diabetes
Patient or population: women with pre‐existing diabetes Setting: two studies in Italy, one study in Poland Intervention: automated telemedicine monitoring Comparison: conventional monitoring
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with conventional monitoring	Risk with automated telemedicine monitoring
Hypertensive disorders of pregnancy: pre‐eclampsia, gestational hypertension	Study population			(0 studies)		The included studies did not report this outcome.

Hypertensive disorders of pregnancy: gestational hypertension	Study population			(0 studies)		The included studies did not report this outcome.

Caesarean section	Study population		RR 0.96 (0.62 to 1.48)	32 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	733 per 1000	704 per 1000 (455 to 1000)
Glycaemic control during/end of treatment: maternal HbA1c (%)	The mean maternal HbA1c ranged from 5.7 to 6.7%	The mean maternal HbA1c with automated telemedicine monitoring as 0.17 lower (0.82 lower to 0.48 higher)		82 (3 RCTs)	⊕⊝⊝⊝ VERY LOW ^{3 4 5}
Glycaemic control during/end of treatment: maternal post‐prandial blood glucose (mmol/L)	The mean maternal post‐prandial blood glucose ranged from 6.9 to 7.6%	The mean post‐prandial blood glucose with automated telemedicine monitoring as 0.80 lower (1.67 lower to 0.08 higher)		50 (2 RCTs)	⊕⊝⊝⊝ VERY LOW ^{3 5 6}
Large‐for‐gestational age	Study population			(0 studies)		The included studies did not report this outcome.

Perinatal mortality	Study population			(0 studies)		The included studies did not report this outcome.

Preterm birth less than 37 weeks' gestation	Study population			(0 studies)		The included studies did not report this outcome.

Preterm birth less than 34 weeks' gestation	Study population			(0 studies)		The included studies did not report this outcome.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ One study with serious design limitations. ² Wide CI crossing the line of no effect, few events and small sample size. ³ Studies had design limitations. ⁴ Statistical heterogeneity (I² = 82%). ⁵ Wide CI crossing the line of no effect, and small sample size. ⁶ Statistical heterogeneity (I² = 86%).

Summary of findings 4. Automated telemedicine monitoring compared to conventional for women with pre‐existing diabetes

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Summary of findings 5. Continuous glucose monitoring compared to intermittent glucose monitoring for women with pre‐existing diabetes

Continuous glucose monitoring compared to intermittent glucose monitoring for women with pre‐existing diabetes
Patient or population: women with pre‐existing diabetes Setting: one study in Denmark, one study in the UK Intervention: continuous glucose monitoring Comparison: intermittent glucose monitoring
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with intermittent glucose monitoring	Risk with continuous glucose monitoring
Hypertensive disorders of pregnancy: pre‐eclampsia	Study population		RR 1.37 (0.52 to 3.59)	225 (2 RCTs)	⊕⊕⊝⊝ LOW ¹
	56 per 1000	76 per 1000 (29 to 199)
Hypertensive disorders of pregnancy: gestational hypertension	Study population			(0 studies)		The included studies did not report this outcome.

Caesarean section	Study population		RR 1.00 (0.65 to 1.54)	225 (2 RCTs)	⊕⊝⊝⊝ VERY LOW ^{2 3}
	481 per 1000	481 per 1000 (313 to 741)
Glycaemic control during/end of treatment: maternal HbA1c (%)	The mean maternal HbA1c was 6.4%	The mean maternal HbA1c with continuous glucose monitoring was 0.60 lower (0.91 lower to 0.29 higher)		71 (1 RCT)	⊕⊕⊕⊝ MODERATE ⁴
Glycaemic control during/end of treatment: post‐prandial blood glucose				(0 studies)		The included studies did not report this outcome.
Large‐for‐gestational age	Study population		RR 0.89 (0.41 to 1.92)	221 (2 RCTs)	⊕⊝⊝⊝ VERY LOW ^{3 5}
	410 per 1000	364 per 1000 (168 to 786)
Perinatal mortality	Study population		RR 0.82 (0.05 to 12.61)	71 (1 RCT)	⊕⊕⊝⊝ LOW ¹
	31 per 1000	26 per 1000 (2 to 394)
Preterm birth less than 37 weeks	Study population		RR 1.10 (0.63 to 1.94)	228 (2 RCTs)	⊕⊕⊝⊝ LOW ¹
	167 per 1000	183 per 1000 (105 to 323)
Preterm birth less than 34 weeks' gestation	Study population			(0 studies)		The included studies did not report this outcome.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Wide CI crossing the line of no effect, few events and small sample size. ² Statistical heterogeneity (I² = 62%). ³ Wide CI crossing the line of no effect, and small sample size. ⁴ Small sample size. ⁵ Statistical heterogeneity (I² = 82%).

Summary of findings 5. Continuous glucose monitoring compared to intermittent glucose monitoring for women with pre‐existing diabetes

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Summary of findings 6. Constant CGM compared to Intermittent CGM for women with pre‐existing diabetes

Constant CGM compared to Intermittent CGM for women with pre‐existing diabetes
Patient or population: women with pre‐existing diabetes Setting: one study in Macedonia Intervention: constant CGM Comparison: intermittent CGM
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with Intermittent CGM	Risk with constant CGM
Hypertensive disorders of pregnancy: pre‐eclampsia	Study population			(0 studies)		The included study did not report this outcome.

Hypertensive disorders of pregnancy: gestational hypertension	Study population			(0 studies)		The included study did not report this outcome.

Caesarean section	Study population		RR 0.77 (0.33 to 1.79)	25 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	538 per 1000	415 per 1000 (178 to 964)
Glycaemic control during/end of treatment: maternal HbA1c (3rd trimester) (%)	The mean maternal HbA1c (3rd trimester) was 6.23%	The mean maternal HbA1c with constant CGM was 0.09 lower (0.69 lower to 0.51 higher)		25 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 3}
Glycaemic control during/end of treatment: maternal blood glucose (3rd trimester) (mmmol/L)	The mean maternal blood glucose (3rd trimester) was 0	The mean maternal blood glucose (3rd trimester) with constant CGM was 0.14 lower (2.00 lower to 1.72 higher)		25 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 3}
Large‐for‐gestational age	Study population			(0 studies)		The included study did not report this outcome.

Perinatal mortality	Study population			(0 studies)		The included study did not report this outcome.

Preterm birth less than 37 weeks' gestation	Study population		RR 1.08 (0.08 to 15.46)	25 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	77 per 1000	83 per 1000 (6 to 1000)
Preterm birth less than 34 weeks' gestation	Study population			(0 studies)		The included study did not report this outcome.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ One study with design limitations. ² Wide CI crossing the line of no effect, few events and small sample size. ³ Wide CI crossing the line of no effect, and small sample size.

Summary of findings 6. Constant CGM compared to Intermittent CGM for women with pre‐existing diabetes

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Comparison 1. Self‐monitoring versus standard care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.40, 1.49]

2 Perinatal mortality Show forest plot	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 67.91]

3 Neonatal mortality and morbidity composite Show forest plot	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 67.91]

4 Glycaemic control during/end of treatment (maternal post‐prandial blood glucose) Show forest plot	1	13	Mean Difference (IV, Fixed, 95% CI)	‐0.70 [‐2.15, 0.75]

5 Glycaemic control during/end of treatment (maternal HbA1c) Show forest plot	1	28	Mean Difference (IV, Fixed, 95% CI)	‐0.10 [‐1.93, 1.73]

6 Miscarriage Show forest plot	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.55]

7 Neonatal mortality Show forest plot	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 67.91]

8 Gestational age at birth Show forest plot	1	28	Mean Difference (IV, Fixed, 95% CI)	0.40 [‐1.65, 2.45]

9 Birthweight Show forest plot	2	41	Mean Difference (IV, Fixed, 95% CI)	‐0.18 [‐0.49, 0.13]

10 Respiratory distress syndrome Show forest plot	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 67.91]

11 Neonatal hypoglycaemia Show forest plot	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.21, 1.52]

12 Neonatal jaundice (hyperbilirubinaemia) Show forest plot	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.25, 1.24]

13 Neonatal hypocalcaemia Show forest plot	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.45]

14 Neonatal polycythaemia Show forest plot	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.55]

15 Neonatal cord vein C‐peptide Show forest plot	1	28	Mean Difference (IV, Fixed, 95% CI)	0.13 [‐0.50, 0.76]

Comparison 1. Self‐monitoring versus standard care

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Comparison 2. Self‐monitoring versus hospitalisation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pre‐eclampsia Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	4.26 [0.52, 35.16]

2 Hypertension in pregnancy Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.43 [0.08, 2.22]

3 Caesarean section Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.65, 1.44]

4 Perinatal mortality Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.05, 13.24]

5 Placental abruption Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.70 [0.16, 18.19]

6 Preterm birth < 37 weeks Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.45, 1.60]

7 Respiratory distress syndrome Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	2.56 [0.28, 23.74]

8 Neonatal hypoglycaemia Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.50, 2.03]

9 Neonatal jaundice (hyperbilirubinaemia) Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	2.27 [0.64, 8.07]

10 Major anomalies Show forest plot	1	102	Risk Ratio (M‐H, Fixed, 95% CI)	0.27 [0.03, 2.54]

11 Antenatal hospital admission Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.19 [0.11, 0.33]

12 Feeding difficulties (not pre‐specified) Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.41, 1.78]

Comparison 2. Self‐monitoring versus hospitalisation

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Comparison 3. Pre‐prandial versus post‐prandial glucose monitoring

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pre‐eclampsia Show forest plot	1	58	Risk Ratio (M‐H, Fixed, 95% CI)	6.43 [0.82, 50.11]

2 Caesarean section Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.45 [0.92, 2.28]

3 Large‐for‐gestational age Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.73, 1.85]

4 Perinatal mortality Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	2.91 [0.12, 68.66]

5 Weight gain during pregnancy Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	‐0.90 [‐3.86, 2.06]

6 Insulin dose Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	‐17.40 [‐43.41, 8.61]

7 Glycaemic control ‐ Insulin dose Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐0.45, 0.05]

8 Glycaemic control ‐ HbA1c Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐0.08, 0.68]

9 Stillbirth Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	2.91 [0.12, 68.66]

10 Gestational age at birth Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐0.84, 1.24]

11 Preterm birth < 37 weeks Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.62, 2.84]

12 Macrosomia Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	2.18 [0.75, 6.32]

13 Birthweight Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	0.24 [‐0.10, 0.58]

14 Adiposity ‐ Subscapula skinfold thickness Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	0.60 [‐0.18, 1.38]

15 Adiposity ‐ Triceps skinfold thickness Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	0.60 [0.04, 1.16]

16 Birth trauma (shoulder dystocia, bone fracture, nerve palsy) (not pre‐specified as a composite) Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.05, 5.06]

17 Respiratory distress syndrome Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.06, 14.78]

18 Neonatal hypoglycaemia Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.48, 2.45]

19 Neonatal jaundice (hyperbilirubinaemia) Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.40, 3.40]

20 Cord IGF‐1 Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	1.30 [‐0.70, 3.30]

21 Neonatal glucose at age 1 hour (not pre‐specified) Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐0.88, 0.48]

22 Transient tachypnea (not pre‐specified) Show forest plot	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	2.58 [0.76, 8.81]

23 Neonatal intensive care admissions Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.62, 1.74]

Comparison 3. Pre‐prandial versus post‐prandial glucose monitoring

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Comparison 4. Automated telemedicine monitoring versus conventional

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.62, 1.48]

2 Neonatal morbidity composite Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.53, 2.62]

3 Weight gain during pregnancy [kg] Show forest plot	1	32	Mean Difference (IV, Fixed, 95% CI)	‐0.70 [‐4.95, 3.55]

4 Use of additional insulin therapy Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.89, 1.12]

5 Insulin requirement at end of study Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	18.4 [12.88, 23.92]

6 Glycaemic control ‐ Maternal fasting blood glucose: before breakfast Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐1.0 [‐1.22, ‐0.78]

7 Glycaemic control ‐ Maternal fasting blood glucose: before lunch Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐1.10 [‐1.32, ‐0.88]

8 Glycaemic control ‐ Maternal HbA1c Show forest plot	3	82	Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.82, 0.48]

9 Glycaemic control ‐ Maternal post‐prandial blood glucose Show forest plot	2	50	Mean Difference (IV, Random, 95% CI)	‐0.80 [‐1.67, 0.08]

10 Gestational age at birth Show forest plot	3	84	Mean Difference (IV, Fixed, 95% CI)	0.13 [‐0.14, 0.39]

11 Macrosomia Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.31, 4.43]

12 Birthweight Show forest plot	1	32	Mean Difference (IV, Fixed, 95% CI)	‐0.16 [‐0.64, 0.32]

Comparison 4. Automated telemedicine monitoring versus conventional

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Comparison 5. Continuous glucose monitoring versus intermittent glucose monitoring

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pre‐eclampsia Show forest plot	2	225	Risk Ratio (M‐H, Fixed, 95% CI)	1.37 [0.52, 3.59]

2 Caesarean section Show forest plot	2	225	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.65, 1.54]

3 Large‐for‐gestational age Show forest plot	2	221	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.41, 1.92]

4 Perinatal mortality Show forest plot	1	71	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.05, 12.61]

5 Glycaemic control ‐ Maternal HbA1c Show forest plot	1	71	Mean Difference (IV, Fixed, 95% CI)	‐0.60 [‐0.91, ‐0.29]

6 Miscarriage Show forest plot	2	228	Risk Ratio (M‐H, Fixed, 95% CI)	1.21 [0.28, 5.24]

7 Neonatal mortality Show forest plot	1	74	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.05, 12.39]

8 Gestational age at birth Show forest plot	1	68	Mean Difference (IV, Fixed, 95% CI)	0.10 [‐0.57, 0.77]

9 Preterm birth < 37 weeks Show forest plot	2	228	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.63, 1.94]

10 Small‐for‐gestational age Show forest plot	1	67	Risk Ratio (M‐H, Fixed, 95% CI)	7.34 [0.41, 131.18]

11 Birthweight Show forest plot	1	67	Mean Difference (IV, Fixed, 95% CI)	‐0.29 [‐0.59, 0.01]

12 Neonatal hypoglycaemia Show forest plot	2	228	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.51, 1.16]

13 Major anomalies Show forest plot	1	74	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.05, 12.39]

14 Neonatal intensive care unit admissions Show forest plot	1	74	Risk Ratio (M‐H, Fixed, 95% CI)	1.21 [0.48, 3.05]

Comparison 5. Continuous glucose monitoring versus intermittent glucose monitoring

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Comparison 6. Constant CGM versus intermittent CGM

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	25	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.33, 1.79]

2 Weight gain during pregnancy Show forest plot	1	25	Mean Difference (IV, Fixed, 95% CI)	0.5 [‐1.82, 2.82]

3 Insulin dosage, 3^rd trimester (IU/kg/day) Show forest plot	1	25	Mean Difference (IV, Fixed, 95% CI)	‐0.03 [‐1.30, 1.24]

4 Glycaemic control ‐ Maternal blood glucose (1st trimester) Show forest plot	1	25	Mean Difference (IV, Fixed, 95% CI)	‐0.5 [‐2.70, 1.70]

5 Glycaemic control ‐ Maternal blood glucose (3rd trimester) Show forest plot	1	25	Mean Difference (IV, Fixed, 95% CI)	‐0.14 [‐2.00, 1.72]

6 Glycaemic control ‐ Maternal HbA1c (1st trimester) Show forest plot	1	25	Mean Difference (IV, Fixed, 95% CI)	‐0.30 [‐1.13, 0.53]

7 Glycaemic control ‐ Maternal HbA1c (3rd trimester) Show forest plot	1	25	Mean Difference (IV, Fixed, 95% CI)	‐0.09 [‐0.69, 0.51]

8 Maternal hypoglycemia Show forest plot	1	25	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.06, 5.24]

9 Diabetic ketoacidosis (not pre‐specified) Show forest plot	1	25	Risk Ratio (M‐H, Fixed, 95% CI)	0.36 [0.02, 8.05]

10 Preterm birth < 37 weeks Show forest plot	1	25	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.08, 15.46]

11 Macrosomia Show forest plot	1	25	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.08, 15.46]

12 Neonatal hypoglycaemia Show forest plot	1	25	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 6. Constant CGM versus intermittent CGM

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