From the Research
For pregnant patients with diabetes, A1C testing is recommended at the first prenatal visit to establish a baseline, then every 4-8 weeks throughout pregnancy. This frequent monitoring is essential because pregnancy creates unique metabolic demands that can rapidly alter glycemic control. A1C provides valuable information about average blood glucose levels over the previous 2-3 months, complementing daily glucose monitoring. However, it's important to note that A1C values tend to be lower in pregnancy due to increased red blood cell turnover, so target A1C levels are typically stricter during pregnancy (<6.0-6.5%) compared to non-pregnant patients. Some key points to consider when implementing A1C testing for pregnant patients with diabetes include:
- Testing should occur at the initial visit, followed by monitoring once per trimester, with more frequent testing (every 4-6 weeks) for those with poor glycemic control or who require medication adjustments 1, 2, 3, 4, 5.
- Regular A1C testing helps healthcare providers make timely adjustments to treatment plans to maintain optimal glucose control, which is crucial for reducing risks of complications for both mother and baby.
- The use of continuous glucose monitoring (CGM) has been shown to be beneficial in improving glycemic control and reducing hypoglycemia in patients with diabetes, including those with type 2 diabetes treated with basal insulin without prandial insulin 2.
- CGM can provide detailed information about glycaemic variability, enabling more informed user and clinician decision making, and has been shown to be cost-effective in type 1 diabetes management 5.