Controversies in the peripartum management of diabetes

“…It may not be unreasonable therefore to relax target CBGs to 4-8 mmol/L or even 6-8 mmol/L where hypoglycaemia can have disastrous consequences. 9 However, further research is urgently needed to confirm that such relaxation would not have a deleterious effect on the neonatal outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…7 They also raised concerns that maintaining tight glycaemic control in the range of 4-7 mmol/L may increase maternal hypoglycaemia and resource burden without any clear reduction in neonatal hypoglycaemia. 8,9 Our local protocol is to monitor capillary blood glucose (CBG) hourly from the onset of labour in all women with diabetes. If CBGs rise above 7 mmol/L, the variable rate intravenous insulin infusion (VRIII) is commenced ( Figure 1).…”

Section: Introductionmentioning

confidence: 99%

The feasibility and impact of implementing NICE guidance on diabetes control during delivery

et al. 2017

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Aims: The aim of this study was to report on the practicality, feasibility and impact of implementing the National Institute for Health and Care Excellence (NICE) guidelines for the control of diabetes in women during labour and birth. Methods: We analysed case records of pregnant women with diabetes who delivered in the period between July 2014 and June 2015. The data were collected in relation to the availability of a plan in the notes, capillary blood glucose (CBG) monitoring, use of variable rate intravenous insulin infusion (VRIII), maintenance of CBG targets within 4-7 mmol/L, maternal hypoglycaemia during labour and neonatal hypoglycaemia. Results: Fifty-one women with diabetes delivered during this period. Only 45% of women were monitored by complete hourly CBGs until delivery. 27.4% of women had CBG ≥7 mmol/L but only 17.6% were started on VRIII. The VRIII group had a 22.2% incidence of minor maternal hypoglycaemia. Neonatal hypoglycaemia occurred in 47% of the babies. Conclusion: A CBG target of 4-7 mmol/L during labour and initiation of VRIII when levels are above this target in pregnant women with diabetes is difficult to achieve and is associated with some maternal hypoglycaemia. Repeat CBG measurements within half an hour and strict adherence to clear guidelines and protocols supported by more education and adequate staffing may improve results.Br J Diabetes 2017;17:ONLINE AHEAD OF PUBLICATION

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“…This stringent target range is based on the rationale that hyperglycaemia during the peripartum period increases the risk of neonatal hypoglycaemia. The literature cited by NICE supporting this notion was mostly published more than 20 years ago, before the advent of improved glycaemic control during pregnancy . More recent data, including a systematic review , the prospective trial by Yamamoto et al.…”

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confidence: 99%

“…These parturients represent a high‐risk group as maternal hyperglycaemia is associated with an increased incidence of miscarriage, sepsis and pre‐eclampsia and, as gestational diabetes is associated with obesity and increased maternal age, they are at further risk of complications . Furthermore, neonates of parturients with diabetes are at greater risk of hypoglycaemia, macrosomia, birth injuries, congenital abnormalities and peri‐natal mortality .…”

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confidence: 99%

Utilising the multidisciplinary concepts of peri‐operative medicine to improve the outcome of the parturient with diabetes

2020

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tracheal tube and to reduce the occurrence of inductionrelated AAGA. These statements and their rationale are summarised in Table 1.We congratulate Jelacic et al. and DAS for their efforts to enhance safety and pre-induction preparation through the use of checklists. Moreover, in line with other safetyconscious industries, we suggest the anaesthetic community considers adopting the practice of 'verbalisation', especially during the period of tracheal intubation.

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Controversies in the peripartum management of diabetes

Cited by 15 publications

References 38 publications

‘Primum non nocere’ (first do no harm). Intrapartum glycaemic control and neonatal hypoglycaemia

‘Primum non nocere’ (first do no harm). Intrapartum glycaemic control and neonatal hypoglycaemia

The feasibility and impact of implementing NICE guidance on diabetes control during delivery

Utilising the multidisciplinary concepts of peri‐operative medicine to improve the outcome of the parturient with diabetes

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