Dr Jake Halliday1, Dr Sue Mei Lau1, Dr Wendy Hawke1, Debra Bezuidenhout2, Justine Darling1, Professor Sandra Lowe1, Dr Amanda Beech1, Virginia Spear1, Dr Srinivas Bolisetty1, Sally Wise1, Dr Sarah Lyons1, A/Prof Helen Barrett1
1Royal Hospital For Women, Randwick, Australia, 2NSW Health Pathology (SEALS), Randwick, Australia
Biography:
Dr Jake Halliday is a fourth-year obstetric registrar currently working at the Royal Hospital for Women
Abstract:
Objective: To evaluate the neonatal and maternal outcomes associated with a liberal approach to blood glucose level management during labour in women diagnosed with gestational diabetes (GDM).
Methods: This retrospective cohort study examined labour and delivery outcomes among women with GDM at a tertiary maternity unit. A liberal blood glucose management protocol was implemented for term women in labour with a singleton pregnancy. The primary outcomes measured were: (1) rate of neonatal hypoglycaemia (Blood glucose <2.6 mmol/L), (2) rate of neonatal intensive care unit (NICU) admission due to neonatal hypoglycaemia, and (3) frequency of blood glucose level monitoring during labour. Sub-group analyses were conducted based on type of GDM management (diet-controlled, metformin, or insulin), maternal age, body mass index (BMI), and parity.
Results: The study included 50 women with GDM. Of these, 52% were diet-controlled, 8% were managed with metformin, and 40% required insulin. Blood glucose levels were performed intermittently in labour for 54% of participants. The overall rate of neonatal hypoglycaemia was 14%, with 6% of neonates requiring NICU admission due to hypoglycaemia. Maternal age, BMI, and parity were not statistically significant predictors of neonatal hypoglycaemia. This data set is currently preliminary as we plan to expand the cohort to 400 women.
Conclusions: A liberal approach to blood glucose management in labour for women with GDM resulted in a 14% rate of hypoglycaemia, with 6% of neonates admitted to the NICU for monitoring. This rate was lower for those managed with diet or metformin, with insulin-dependent GDM patients demonstrating a higher risk. These findings suggest that individualised blood glucose management protocols may be beneficial, particularly in cases requiring insulin therapy. Further studies are warranted to refine GDM management strategies during labour.
Keywords
gestational diabetes, labour, neonatal hypoglycaemia
References
1. Hamel MS, Kanno LM, Has P, Beninati MJ, Rouse DJ, Werner EF. Intrapartum glucose management in women with gestational diabetes mellitus: a randomized controlled trial. Obstetrics & Gynecology. 2019 Jun 1;133(6):1171-7.
2. Zelivianskaia AS, Iqbal SN, Mclaughlin A, Kette B, Leibold A. Association Between Maternal Glucose Control Intrapartum, Glucose Control Antepartum, and Neonatal Hypoglycemia [35G]. Obstetrics & Gynecology. 2019 May 1;133:82S-3S.
3. Roman A, Moreno S, Lynch T, Berghella V. 526: Intrapartum glycemic control and risk of neonatal hypoglycemia. American Journal of Obstetrics & Gynecology. 2017 Jan 1;216(1):S310-1.