Intrapartum glycaemic control and neonatal hypoglycaemia in pregnancies complicated by diabetes: a systematic review

Yamamoto, Jennifer M.; Benham, Jamie L; Mohammad, Khorshid; Donovan, Lois; Wood, SL

doi:10.1111/dme.13546

Cited by 52 publications

(49 citation statements)

References 38 publications

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“…E-mail: helen.murphy@uea.ac.uk insulin pump or novel automated glucose-responsive closedloop insulin delivery [11,12]. However, without automated insulin delivery and with the current tight glycaemic targets during this period, maternal hypoglycaemia is far too common [9]. Women spend > 80% of time in target during the 24 h prior to delivery.…”

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confidence: 99%

Inpatient hypoglycaemia; should we should we focus on the guidelines, the targets or our tools?

Yamamoto

Murphy

2018

Diabet. Med.

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In their thought-provoking commentary, Levy et al. [1] explore the possible unintended consequences of United Kingdom (UK) guideline targets on the high frequency of hypoglycaemia in people with diabetes who are hospitalized. The authors cite the National Institute for Health and Care Excellence (NICE) and the Joint British Diabetes Societies (JBDS) guidelines pertaining to inpatient, surgical and pregnancy diabetes care. These guidelines suggest using lower limits of glucose targets varying from 4.0 to 6.0 mmol/l [2-4]. Levy et al. propose a lower glucose limit of 5 mmol/l with the catchphrase 'stop at 5 and keep the inpatient alive'. This article is protected by copyright. All rights reserved.

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confidence: 99%

Inpatient hypoglycaemia; should we should we focus on the guidelines, the targets or our tools?

Yamamoto

Murphy

2018

Diabet. Med.

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“…E-mail: dashora@hotmail.com hypoglycaemia occurred, at an incidence as high as one episode per 10 h of intravenous insulin [6]. Others have reported zero maternal hypoglycaemia [7] and 7 of 23 studies in a recent metaanalysis did not report any maternal hypoglycaemia [8]. Others have reported zero maternal hypoglycaemia [7] and 7 of 23 studies in a recent metaanalysis did not report any maternal hypoglycaemia [8].…”

Section: Accepted 3 September 2018mentioning

confidence: 99%

National guidelines have contributed to safer care for inpatients with diabetes

et al. 2018

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The Commentary by Levy et al. [1] argues that the high incidence of inpatient hypoglycaemia in the recent National Diabetes Inpatient Audit (NaDIA) is not simply down to 'errors' by clinicians, but also to 'system defects in national guidance'. We agree that inpatient hypoglycaemia and the wider issue of inpatient safety are extremely important, and recognize the importance of the unique anaesthetic perspective. This article is protected by copyright. All rights reserved.

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“…1 Peripartum maternal hyperglycemia is frequently, but inconsistently, associated with a higher risk of neonatal hypoglycemia. 2 Thus, tight glucose control during labor and delivery is generally recommended. [3][4][5] The physiological stresses and dramatic changes in insulin doses during labor and delivery, supervised by obstetric ward staff with limited diabetes expertise, represent a unique challenge.…”

Section: Introductionmentioning

confidence: 99%

Adaptability of Closed-Loop during Labor, Delivery, and Postpartum—A Secondary Analysis of Data From Two Randomized Crossover Trials in Type 1 Diabetes Pregnancy

Yamamoto¹,

Stewart²,

Wilinska³

et al. 2018

Diabetes

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Tight glucose control during labor and delivery is recommended for pregnant women with type 1 diabetes. This can be challenging to achieve using the current treatment modalities. The automated nature of closed loop and its ability to adapt to real-time glucose levels make it well suited for use during labor, delivery, and the immediate postpartum period. We report observational data of participants from two randomized crossover trials who chose to continue using closed loop during labor, delivery, and postpartum. Labor was defined as the 24 h before delivery and postpartum as the 48 h after delivery. The glucose target range during pregnancy was 3.5-7.8 mmol/L (63-140 mg/dL) and 3.9-10 mmol/L (70-180 mg/dL) after delivery. Twenty-seven (84.4%) of the potential 32 trial participants used closed loop through labor, delivery, and postpartum. Use of closed loop was associated with 82.0% (interquartile range [IQR] 49.3, 93.0) time-in-target range during labor and delivery and a mean glucose of 6.9 -1.4 mmol/L (124 -25 mg/dL). Closed loop performed well throughout vaginal, elective, and emergency cesarean section deliveries. Postpartum, women spent 83.3% (IQR 75.2, 94.6) time-intarget range (3.9-10.0 mmol/L [70-180 mg/dL]), with a mean glucose of 7.2 -1.4 mmol/L (130 -25 mg/dL). There was no difference in maternal glucose concentration between mothers of infants with and without neonatal hypoglycemia (6.9 -1.6 mmol/L and 6.8 -1.1 mmol/L [124 -29 mg/dL and 122 -20 mg/dL] respectively; P = 0.84). Automated closed-loop insulin delivery is feasible during hospital admissions for labor, delivery, and postpartum. Larger scale studies are needed to evaluate its efficacy compared with current clinical approaches as well as understand how women and healthcare providers will adopt this technology.

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Intrapartum glycaemic control and neonatal hypoglycaemia in pregnancies complicated by diabetes: a systematic review

Abstract: There is a paucity of high-quality data supporting the association of glucose during labour and delivery with neonatal hypoglycaemia in pregnancies complicated by diabetes. Further studies are required to examine the impact of tight glycaemic targets in labour.

Cited by 52 publications

References 38 publications

Inpatient hypoglycaemia; should we should we focus on the guidelines, the targets or our tools?

Inpatient hypoglycaemia; should we should we focus on the guidelines, the targets or our tools?

National guidelines have contributed to safer care for inpatients with diabetes

Adaptability of Closed-Loop during Labor, Delivery, and Postpartum—A Secondary Analysis of Data From Two Randomized Crossover Trials in Type 1 Diabetes Pregnancy

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