Glucose Control During Labour In Diabetic Women

Ryan, Edmond A.; Sia, Winnie; Khurana, Rshmi; Marnoch, Catherine A.; Nerenberg, Kara; Ghosh, Mahua

doi:10.1016/s1701-2163(16)35462-7

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…In the present study, we describe a protocol on subcutaneous insulin administration during labour and delivery with resulting median self‐monitored plasma glucose values within target range and relatively rare maternal hypoglycaemia . This finding adds to the debate on the mode of insulin delivery during labour and delivery .…”

Section: Discussionmentioning

confidence: 86%

“…However, comparison with other studies is difficult as neonatal hypoglycaemia is often referred to as glucose values < 2.0 mmol/l [10,11,23,24], and the threshold for therapy and the type of preventative regimen vary [11,13,24]. There are several published protocols on how to achieve maternal euglycaemia during labour and delivery in women with diabetes [8,[10][11][12][24][25][26][27]. Glucose requirements undoubtedly increase during labour and delivery [12] and many protocols include intravenous glucose infusion [11,12,24,25,27].…”

Section: Discussionmentioning

confidence: 99%

“…There are several published protocols on how to achieve maternal euglycaemia during labour and delivery in women with diabetes [8,[10][11][12][24][25][26][27]. Glucose requirements undoubtedly increase during labour and delivery [12] and many protocols include intravenous glucose infusion [11,12,24,25,27]. One study including 12 women with diabetes found diminished insulin requirements during active labour [26].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Real‐time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes — observations from a randomized controlled trial

et al. 2013

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Real‐time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes — observations from a randomized controlled trial

et al. 2013

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“…Optimization of glycemic control in the weeks up to delivery and during labor is important to reduce the risk of neonatal hypoglycemia. It is recommended that intravenous insulin is used once active labor starts (cervix dilated by 3 cm and/or rupture of membranes) to achieve near normal capillary blood glucose values [35,57]. As with other high-risk pregnancies, cardiotocography should be used to monitor the progression of labor and detect fetal distress.…”

Section: Peripartum Carementioning

confidence: 99%

Managing pregnancy in women with Type 1 diabetes

O'Sullivan¹,

Hewapathirana²,

Murphy³

2013

Diabetes Management

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Pregnancy in women with Type 1 diabetes is associated with an increased risk of complications for both the woman and her offspring. The risks can be effectively ameliorated when women are managed by experienced, multidisciplinary obstetric diabetes teams, emphasizing pre-pregnancy planning with tight glycemic control before and during pregnancy, and close monitoring during labor, delivery and postpartum. This review describes the issues particular to Type 1 diabetes pregnancy and how best to manage these pregnancies to minimize negative outcomes. There is also a brief description of recent developments in the field and current research on novel therapies.Pre-pregnancy counseling is paramount in the optimal management of pregnancy in Type 1 diabetes.Good glycemic control before and during pregnancy reduces the risk of fetal and maternal complications.Screening for retinopathy, nephropathy, vascular and/or thromboembolic risk factors with appropriate management before and during pregnancy is important.Tight glycemic control using frequent glucose monitoring, appropriate dietary modification and intensive insulin regimens, balancing the risk of hypoglycemia to the mother with fetal complications of hyperglycemia, remains the mainstay of management.Ultrasound scan evaluation is important primarily to detect structural anomalies (with detailed four-chamber cardiac views) and later to monitor the fetal growth trajectory.Closely monitored labor with neonatology input is required in 30-40% infants; therefore, delivery should be done in a center equipped with a specialist multidisciplinary team.

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“…Observational studies have suggested that higher maternal blood glucose during labour might also be a predictor for neonatal hypoglycaemia . Thus, many centres have protocols for women with GDM that include dextrose/insulin intravenous infusions to optimise glucose control prior to delivery with the aim of reducing rates of neonatal hypoglycaemia …”

Section: Introductionmentioning

confidence: 99%

The use of dextrose/insulin infusions during labour and delivery in women with gestational diabetes mellitus: Is there any point?

Farrant

Williamson

Battin

et al. 2016

Aust NZ J Obst Gynaeco

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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.

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Glucose Control During Labour In Diabetic Women

Cited by 8 publications

References 15 publications

Real‐time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes — observations from a randomized controlled trial

Real‐time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes — observations from a randomized controlled trial

Managing pregnancy in women with Type 1 diabetes

The use of dextrose/insulin infusions during labour and delivery in women with gestational diabetes mellitus: Is there any point?

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