A standardized protocol to achieve normoglycaemia during labour and delivery in women with type 1 diabetes.
OBJECTIVE
To evaluate a standardized protocol for maintaining near-normoglycaemia during labour and delivery in women with type 1 diabetes.


METHODS
Over a nine-year period (1997-2005), 229 pregnancies in 174 women with type 1 diabetes were delivered at one centre. The same regimen was used for the induction of labour (group 1) and in women admitted in spontaneous labour (group 2): 10% dextrose (80ml/h) intravenous was given along with short-acting insulin, starting at 1IU/h intravenous via an infusion pump. Capillary blood glucose (CBG) was determined hourly, and the insulin infusion rate was modified accordingly.


RESULTS
Labour was induced in 85 cases (37%) and spontaneous in 23 cases (10%), and an elective C-section was performed in 121 cases (53%). Maternal glycaemia during labour was 6.1+/-1.6 (range: 3.9-9.2)mmol/l in group 1, and 6.9+/-2.0 (range: 4.7-12.0)mmol/l in group 2. Maternal glycaemia at delivery was 5.8+/-1.5 (range: 3.4-9.4) and 6.3+/-1.9 (range: 4.1-11.4)mmol/l in groups 1 and 2, respectively. Women who underwent an elective C-section were not included in the standardized protocol and had higher glycaemia at delivery 7.1+/-2.0 (range: 2.7-13.5)mmol/l. Neonatal hypoglycaemia occurred in 30 infants (13%), and was only associated with preterm delivery.


CONCLUSIONS
Using a standardized simple protocol during labour, maternal glycaemia was maintained within a near-normal range in 80-85% of cases.
Lepercq
J
J
Department of obstetrics and gynecology, AP-HP, hospital Cochin Saint-Vincent-de-Paul, Paris-5 University, 82, avenue Denfert-Rochereau, 75674 Paris cedex 14, France. j.lepercq@svp.aphp.fr
Abbou
H
H
Agostini
C
C
Toubas
F
F
Francoual
C
C
Velho
G
G
Dubois-Laforgue
D
D
Timsit
J
J
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015519:Bone Density; D036861:Delivery, Obstetric; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000502:physiology*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood*
D001786:Blood Glucose; D006442:Glycated Hemoglobin