A standardized protocol to achieve normoglycaemia during labour and delivery in women with type 1 diabetes

Lepercq, J.; Abbou, Hind; Agostini, Camila; Toubas, F; Francoual, C; Dubois‐Laforgue, Danièle; Timsit, José

doi:10.1016/j.diabet.2007.08.003

Cited by 24 publications

(23 citation statements)

References 11 publications

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“…Good glycemic control during delivery minimizes neonatal hypoglycemia (1-5) and possible long-term neurological sequelae (6,7). Hence, since the first report of an insulin infusion in labor (8), this has become the mainstay of management (9,10) to achieve good glycemic control in labor (2,3,(11)(12)(13)(14). In our study, 95% of women were managed with an insulin infusion.…”

Section: Discussionmentioning

confidence: 95%

Peripartum Management of Glycemia in Women With Type 1 Diabetes

et al. 2014

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OBJECTIVEWe aimed to 1) describe the peripartum management of type 1 diabetes at an Australian teaching hospital and 2) discuss factors influencing the apparent transient insulin independence postpartum. RESEARCH DESIGN AND METHODSWe conducted a retrospective review of women with type 1 diabetes delivering singleton pregnancies from 2005 to 2010. Information was collected regarding demographics, medical history, peripartum management and outcome, and breast-feeding. To detect a difference in time to first postpartum blood glucose level (BGL) >8 mmol/L between women with an early (,4 h) and late (>12 h) requirement for insulin postpartum, with a power of 80% and a type 1 error of 0.05, at least 24 patients were required. RESULTSAn intravenous insulin infusion was commenced in almost 95% of women. Univariate analysis showed that increased BMI at term, lower creatinine at term, longer duration from last dose of long-or intermediate-acting insulin, and discontinuation of an insulin infusion postpartum were associated with a shorter time to first requirement of insulin postpartum (P = 0.005, 0.026, 0.026, and <0.001, respectively). There was a correlation between higher doses of insulin commenced postpartum and number of out-of-range BGLs (r[36] = 0.358, P = 0.030) and hypoglycemia (r[36] = 0.434, P = 0.007). Almost 60% had at least one BGL <3.5 mmol/L between delivery and discharge. CONCLUSIONSChanges in the pharmacodynamic profile of insulin may contribute to the transient insulin independence sometimes observed postpartum in type 1 diabetes. A dose of 50-60% of the prepregnancy insulin requirement resulted in the lowest rate of hypoglycemia and glucose excursions. These results require validation in a larger, prospective study.

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Section: Discussionmentioning

confidence: 95%

Peripartum Management of Glycemia in Women With Type 1 Diabetes

et al. 2014

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“…11 In the case of maternal hypoglycemia (< 50 mg/dL [2.7 mmol/L]), profile C was activated, or CSII was stopped for 30 min with 33% intravenous glucose being administered if deemed necessary. All mothers were encouraged to breastfeed as soon as possible.…”

Section: Csii Protocolmentioning

confidence: 99%

“…Even if few articles are available on this topic in type 1 diabetes, 11,14,[17][18][19][20][21] they all agree that the glycemia profile during delivery can influence the maternal-fetal perinatal outcome. Stenninger et al 14 demonstrated an association between maternal glucose concentration within 120 min of delivery and the occurrence of postnatal hypoglycemia or the need of intravenous glucose treatment in infants.…”

mentioning

confidence: 99%

“…Currently there is no general consensus on the optimal peripartum glycemia target values that can allow good perinatal outcomes. Ranges between 70 to 120 or 70 to 140 mg/dL 11,[18][19][20]22,23 seem to be the most accepted therapeutic goals. Few studies have investigated the usefulness of using new technologies, such as CSII (insulin pump) and/or CGM, during delivery to obtain a good intrapartum glycemia profile and a subsequent good maternal and fetal outcome.…”

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confidence: 99%

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Experiences of Continuous Subcutaneous Insulin Infusion in Pregnant Women with Type 1 Diabetes During Delivery from Four Italian Centers: A Retrospective Observational Study

Fresa

Visalli

Blasi

et al. 2013

Diabetes Technology & Therapeutics

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“…There are few papers determining the effectiveness of specific protocols for use in labour where the protocols specifics are detailed (Palmer & Inturissi, 1992;Ramanathan, Khoo, & Arismendy, 1991;Leparcq, et al, 2008;Jovanovic & Petersen, 1983;Hawkins & Casey, 2007). In 1983, using a Biostator®, Jovanovic and Peterson determined that the average hourly need for glucose to cover the needs of labour was 2.55 mg/kg/min (Jovanovic & Petersen, 1983).…”

Section: Approaching the Finish Line -What To Do For Labour And Deliverymentioning

confidence: 99%

Insulin Use in Gestational Diabetes – Pragmatic Protocols for Self-Management and for Labour and Delivery

Meltzer¹,

Alsayari²

2011

Gestational Diabetes

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A standardized protocol to achieve normoglycaemia during labour and delivery in women with type 1 diabetes

Cited by 24 publications

References 11 publications

Peripartum Management of Glycemia in Women With Type 1 Diabetes

Peripartum Management of Glycemia in Women With Type 1 Diabetes

Experiences of Continuous Subcutaneous Insulin Infusion in Pregnant Women with Type 1 Diabetes During Delivery from Four Italian Centers: A Retrospective Observational Study

Insulin Use in Gestational Diabetes – Pragmatic Protocols for Self-Management and for Labour and Delivery

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