Glucose Control During Labour In Diabetic Women

• Published in: Journal of obstetrics and gynaecology Canada Vol. 34; no. 12; pp. 1149 - 1157
• Main Authors: Ryan, Edmond A., MD, Sia, Winnie W., MD, Khurana, Rshmi, MD, Marnoch, Catherine A., MD, Nerenberg, Kara A., MD, Ghosh, Mahua, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-12-2012
• Subjects: Administration, Intravenous; Adult; Canada - epidemiology; Diabetes Mellitus - blood; Diabetes Mellitus - diagnosis; Diabetes Mellitus - drug therapy; Diabetes, Gestational - blood; Diabetes, Gestational - diagnosis; Diabetes, Gestational - drug therapy; Female; Glucose - administration & dosage; Glucose - analysis; glucose control; Humans; Hypoglycemia - prevention & control; Infant, Newborn; Insulin - administration & dosage; Insulin - blood; Labor, Obstetric - blood; labour; Medical Records, Problem-Oriented; Monitoring, Physiologic - methods; neonatal hypoglycemia; Obstetrics and Gynecology; Pregnancy; Pregnancy Complications - blood; Pregnancy Complications - diagnosis; Pregnancy Complications - drug therapy; Pregnancy in Diabetics - epidemiology; Pregnancy Outcome; Retrospective Studies; Treatment Outcome; Canada; Pregnancy; glucose control; neonatal hypoglycemia; labour
• ISSN: 1701-2163
• DOI: 10.1016/S1701-2163(16)35462-7

Abstract Objective Glucose control during labour is important for mother and neonate, with high rates of neonatal hypoglycemia reported in offspring of women with pre-existing or gestational diabetes (48% and 19%, respectively). How glucose control can be achieved is rarely specified. We conducted a chart review of a standardized approach using an iterative intravenous insulin-glucose infusion. Methods We performed a retrospective review of the records of 274 diabetic women during labour. Fifty-five women had type 1 diabetes, 55 had type 2 diabetes, and 164 had gestational diabetes (GDM). The protocol used hourly capillary blood glucose determinations, each prompting changes in insulinglucose infusion rates as required. Outcomes included maternal blood glucose levels three hours before delivery and neonatal hypoglycemia (blood glucose < 2 mmol/L). Results The insulin-glucose infusion was used in 47% of women with type 1, type 2, and gestational diabetes requiring ≥ 0.5 units/kg/day of insulin during pregnancy and in 8% of women with GDM treated by diet or < 0.5 units/kg/day of insulin. The overall rate of maternal hypoglycemia was low (6.6% with blood glucose ≤ 3.5 mmol/L and 1.5% ≤ 3.0 mmol/L) pre-delivery; 13.9% of women had a blood glucose level ≥ 7.0 mmol/L. The neonatal hypoglycemia rate was 7.3% (4.9% in the offspring of women with GDM and 10.9% in the offspring of women with pre-existing diabetes). In women with type 1 and type 2 diabetes and high-dose insulin-requiring GDM, the rate of blood glucose values outside the range of 3.6 to 6.9 mmol/L was lower in those using the intravenous protocol (16.7%) than in those not using it (34.8%), but this reduction was not statistically significant. Conclusion Standardized management for diabetic women in labour using an intravenous insulin-glucose protocol was effective in achieving stable maternal blood glucose levels with low rates of neonatal hypoglycemia.