title: Glucose control during labor and delivery.
abstract: Neonatal hypoglycemia is an important consequence for the infant of the mother with diabetes. We have reviewed 24 published papers of various protocols for control of glucose in pregnant diabetic women during labor and delivery including our own published work. A relationship of maternal glucose during labor and neonatal hypoglycemia was sought in 19 of these studies. A significant inverse relationship was found in 10 reports with 3 others showing a similar trend. In all but 1 of these 13 studies the participants had pregestational diabetes. Three of the 6 studies not reporting an inverse relationship involved women with GDM. From this review it appears that the maternal glucose should be maintained between 4.0 and 6.0-7.0 mmol/L during labor. Most women with gestational diabetes, especially if they require <1.0 units/kg/d of insulin, can simply be monitored without intravenous insulin. Our own results demonstrate that a target glucose of 4.0-6.0 mmol/L can be used safely and results in a low rate of neonatal hypoglycemia using an iterative glucose insulin infusion protocol for women with pregestational diabetes and when needed for women with gestational diabetes.
authors.affiliation: Division of Endocrinology and Metabolism and Alberta Diabetes Institute, 362 Heritage Medical Research Centre, University of Alberta, Edmonton, AB, T6G 2S2, Canada, edmond.ryan@ualberta.ca.
authors.forename: Edmond A
authors.initials: EA
authors.lastname: Ryan
authors.forename: Rany
authors.initials: R
authors.lastname: Al-Agha
mesh_terms: D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects; D036861:Delivery, Obstetric; D016640:Diabetes, Gestational / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D007743:Labor, Obstetric; D011247:Pregnancy
chemical_list: D001786:Blood Glucose; D007328:Insulin