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

Modi, A.; Levy, N.; Hall, George

doi:10.1111/dme.13659

Cited by 2 publications

(2 citation statements)

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“…However, there are insufficient high quality data confirming an association between maternal intrapartum glucose control and neonatal hypoglycaemia. The potential for neonatal benefit must also be balanced against the demands on patients and healthcare teams and risk of maternal hypoglycaemia .…”

Section: Introductionmentioning

confidence: 99%

Maternal glycaemic control and risk of neonatal hypoglycaemia in Type 1 diabetes pregnancy: a secondary analysis of the CONCEPTT trial

et al. 2019

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Aims To examine the relationship between maternal glycaemic control and risk of neonatal hypoglycaemia using conventional and continuous glucose monitoring metrics in the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT) participants. Methods A secondary analysis of CONCEPTT involving 225 pregnant women and their liveborn infants. Antenatal glycaemia was assessed at 12, 24 and 34 weeks gestation. Intrapartum glycaemia was assessed by continuous glucose monitoring measures 24 hours prior to delivery. The primary outcome was neonatal hypoglycaemia defined as glucose concentration < 2.6 mmol/l and requiring intravenous dextrose. Results Neonatal hypoglycaemia occurred in 57/225 (25.3%) infants, 21 (15%) term and 36 (40%) preterm neonates. During the second and third trimesters, mothers of infants with neonatal hypoglycaemia had higher HbA1c [48 ± 7 (6.6 ± 0.6) vs. 45 ± 7 (6.2 ± 0.6); P = 0.0009 and 50 ± 7 (6.7 ± 0.6) vs. 46 ± 7 (6.3 ± 0.6); P = 0.0001] and lower continuous glucose monitoring time‐in‐range (46% vs. 53%; P = 0.004 and 60% vs. 66%; P = 0.03). Neonates with hypoglycaemia had higher cord blood C‐peptide concentrations [1416 (834, 2757) vs. 662 (417, 1086) pmol/l; P < 0.00001], birthweight > 97.7th centile (63% vs. 34%; P < 0.0001) and skinfold thickness (P ≤ 0.02). Intrapartum continuous glucose monitoring was available for 33 participants, with no differences between mothers of neonates with and without hypoglycaemia. Conclusions Modest increments in continuous glucose monitoring time‐in‐target (5–7% increase) during the second and third trimesters are associated with reduced risk for neonatal hypoglycaemia. While more intrapartum continuous glucose monitoring data are needed, the higher birthweight and skinfold measures associated with neonatal hypoglycaemia suggest that risk is related to fetal hyperinsulinemia preceding the immediate intrapartum period.

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Section: Introductionmentioning

confidence: 99%

Maternal glycaemic control and risk of neonatal hypoglycaemia in Type 1 diabetes pregnancy: a secondary analysis of the CONCEPTT trial

et al. 2019

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“…We have previously highlighted the controversy about glucose targets in labour and Yamamoto furthers the debate by reporting the lack of association between in‐target glycaemic control and neonatal hypoglycaemia in 3680 pregnancies in women with diabetes. No doubt this will lead to further calls to relax the current recommendations to reduce the risk of maternal hypoglycaemia while producing similar neonatal outcomes.…”

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confidence: 99%

Baby New Year

Holt

2019

Diabet. Med.

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

Cited by 2 publications

References 8 publications

Maternal glycaemic control and risk of neonatal hypoglycaemia in Type 1 diabetes pregnancy: a secondary analysis of the CONCEPTT trial

Maternal glycaemic control and risk of neonatal hypoglycaemia in Type 1 diabetes pregnancy: a secondary analysis of the CONCEPTT trial

Baby New Year

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