title: The use of dextrose/insulin infusions during labour and delivery in women with gestational diabetes mellitus: Is there any point?
abstract: We compared, in 733 women with gestational diabetes mellitus treated with metformin and/or insulin, rates of neonatal hypoglycaemia in those who had received a dextrose/insulin infusion during labour and prior to delivery (n = 132) with those who did not (n = 601). Women who had infusions were more likely to have been treated with insulin (87.1% vs 70.4%, P < 0.01) and have higher mean capillary glucose values (measured four times daily) in the two weeks prior to delivery (P < 0.01). They had lower mean (SD) glucose values in the 12 h prior to delivery (5.1 (1.1) mmol/L vs 5.4 (0.9) mmol/L, P < 0.01). There was no difference between the groups in rates of neonatal hypoglycaemia (glucose <2.6 mmol/L on two or more occasions), 15.9% versus 17.8%, P = 0.78, or of severe neonatal hypoglycaemia (one or more glucose <1.6 mmol/L), 8.3% versus 5.2%, P = 0.15. In the absence of randomised data comparing use of infusions with no infusions, these data are reassuring for clinicians who do not routinely use infusions.
authors.affiliation: National Women's Health, University of Auckland, Auckland, New Zealand.
authors.forename: Maritza T
authors.initials: MT
authors.lastname: Farrant
authors.affiliation: Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Williamson
authors.affiliation: Newborn Services Auckland City Hospital, Auckland, New Zealand.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Battin
authors.affiliation: Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.|Department of Obstetrics, Women and Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: William M
authors.initials: WM
authors.lastname: Hague
authors.affiliation: National Women's Health, University of Auckland, Auckland, New Zealand.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Rowan
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D016640:Diabetes, Gestational / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007743:Labor, Obstetric; D008687:Metformin / Q000627:therapeutic use; D011247:Pregnancy; D013549:Sweetening Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D013549:Sweetening Agents; D008687:Metformin; D005947:Glucose
keywords: delivery; dextrose/insulin infusion; gestational diabetes mellitus; labour; neonatal hypoglycaemia