317 Type 2 diabetes and neonatal hypoglycemia: role of route of delivery and insulin infusion

Abstract

The primary objective was to compare the rate of neonatal hypoglycemia among individuals with Type 2 diabetes mellitus (T2DM) who attempted labor vs. had planned cesarean delivery (CD); the secondary objective was the rate of neonatal hypoglycemia among T2DM who did not vs had insulin infusion during labor. This was a retrospective cohort study of individuals with insulin treated T2DM and singleton pregnancy who delivered at a single tertiary center between March 2012 and May 2018. Individuals with chronic renal failure, proliferative retinopathy, or major congenital anomalies were excluded. The primary outcome was neonatal hypoglycemia (blood glucose < 40 mg/dl in the first 24 hours of life or < 50 mg/dl >24 hours of age). Secondary outcomes included several maternal and neonatal outcomes (see table). Multivariable Poisson regression models with robust error variance were used to examine the association between groups and the primary outcome Adjusted relative risk (aRR) and 95% confidence intervals (CI) were calculated. Of 233 T2DM, 215 (92.2%) met inclusion criteria, of whom 95 (44%) attempted labor and 120 (56%) had a planned CD. Compared to those with planned CD, individuals who labored had higher gestational age at delivery (36.6 vs 35.8 weeks, p=0.005), and higher blood glucose upon admission (125 vs 103, p<0.001). After adjusting for potential confounders, there was no difference in the risk of neonatal hypoglycemia between the groups (aRR=1.07, 95% CI=0.78-1.48) (Table 1). Among those who attempted labor, 34 (35.8%) required insulin infusion. There was no difference in the risk of neonatal hypoglycemia (aRR=0.79, 95% CI=0.45-1.37) between women who required insulin infusion and those who did not (Table 2). Upwards of 40% of newborns of insulin dependent T2DM have hypoglycemia, irrespective of whether they labored or had planned cesarean, whether they received insulin infusion or not. An improved understanding of modifiable factors which reduce neonatal hypoglycemia is warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)