title: Glucose control during labour in diabetic women.
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 insulin-glucose 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton AB.
authors.forename: Edmond A
authors.initials: EA
authors.lastname: Ryan
authors.affiliation: General Internal Medicine and Maternal Fetal Medicine, Departments of Medicine and Obstetrics, and Gynecology, Heritage Medical Research Centre, Alberta Diabetes Institute, University of Alberta, Edmonton AB.
authors.forename: Winnie W
authors.initials: WW
authors.lastname: Sia
authors.affiliation: General Internal Medicine and Maternal Fetal Medicine, Departments of Medicine and Obstetrics, and Gynecology, Heritage Medical Research Centre, Alberta Diabetes Institute, University of Alberta, Edmonton AB.
authors.forename: Rshmi
authors.initials: R
authors.lastname: Khurana
authors.affiliation: General Internal Medicine and Maternal Fetal Medicine, Departments of Medicine and Obstetrics, and Gynecology, Heritage Medical Research Centre, Alberta Diabetes Institute, University of Alberta, Edmonton AB.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Marnoch
authors.affiliation: General Internal Medicine and Maternal Fetal Medicine, Departments of Medicine and Obstetrics, and Gynecology, Heritage Medical Research Centre, Alberta Diabetes Institute, University of Alberta, Edmonton AB.
authors.forename: Kara A
authors.initials: KA
authors.lastname: Nerenberg
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton AB.
authors.forename: Mahua
authors.initials: M
authors.lastname: Ghosh
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D002170:Canada / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007231:Infant, Newborn; D007328:Insulin / Q000008:administration & dosage / Q000097:blood; D007743:Labor, Obstetric / Q000097:blood*; D008501:Medical Records, Problem-Oriented; D008991:Monitoring, Physiologic / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007328:Insulin; D005947:Glucose