Objective: To examine CGM feedback with the subsequent development of gestational diabetes (GDM), maternal glycaemic control, and glycaemic variability during pregnancy with randomisation 1:1 with one study arm receiving CGM feedback by intermittent scanning (unblinded group), versus masked feedback (blinded group). Design: Prospective, single-center, randomized controlled trial Setting: Single tertiary care hospital Population: Pregnant women recruited in the first trimester of pregnancy Methods: We assessed GDM and plasma glucose levels diagnosed by the 75-g oral glucose tolerance test (OGTT) at 24-28 weeks as a primary outcome. The secondary outcome was CGM-derived parameters of glycaemic variability across the first (9-13 weeks), second (18-23 weeks), late second and early third (24-31 weeks) and third trimester (32-33weeks). Results: Over 47 months, 206 pregnant women were enrolled at 9-13 weeks. There were no significant differences with GDM outcomes, fasting, 1-hour or 2-hour plasma glucose concentrations between study arms. The unblinded group had higher %time-in-range in the first (83.2% vs 78.1%; p=0.06), second [88.7% vs 80.5%; p=0.02] and third trimester (90.2% vs 79.5%; p=0.07), compared to the blinded group. Conversely, the unblinded group had lower %time-below-range in the first trimester (15.4% vs 21.2%; p=0.06), and early second trimester (8.8% vs 16.9%; p=0.05]. No significant differences were observed with the %time-above-range, mean, standard deviation, Mean Amplitude Glycaemic Excursion and % Coefficient Variation across all trimesters. Conclusion: CGM feedback, coupled with better glycaemic control (higher %TIR and low %TBR) indicates its’ potential use in combination with appropriate patient education for promoting better glucose control during pregnancy.

Objective Since the outbreak of Coronavirus Disease 2019 (COVID-19) in Singapore in January 2020, our maternity centre at Singapore General Hospital has devised and implemented contingency protocols to manage COVID-19 suspected or infected pregnant mothers. These aimed to deliver effective care while ensuring the safety of our front-line healthcare workers. Methods The epidemiology and pathogenicity of SARS-COV-2 was compared to the Severe Acute Respiratory Syndrome outbreak in 2003. Our protocols were constructed following multidisciplinary discussions. These workflow processes include triage, isolation, determination of admission criteria and subsequent secured transfers to dedicated isolation wards. Intrapartum management policies including mode of delivery were reviewed with the focus on minimising maternal-fetal transmission. Postpartum care (breastfeeding and skin-to-skin contact) policies were re-evaluated. Results The Centre conducted several multidisciplinary in-situ simulations which identified potential latent threats and deficiencies in infection containment. These were gaps in communication and co-ordination between operating theatre, obstetrics and neonatal teams resulting in delayed transfers. A particular vulnerability was the consistent breaches observed in the donning and doffing of personal protective equipment. This led to a need for additional personnel to guide and police strict adherence among healthcare workers. Conclusion Operational readiness leverage on robust contingency protocols which must be subjected to simulation and scrutiny with subsequent revision. We recommend deploying additional supervisory manpower to maintain strict adherence to infection prevention protocols. Effective preparation is key in maintaining high clinical standards of obstetric care while ensuring safety of healthcare workers during this ongoing pandemic. Funding No funding nor conflicts of interest.