409: Novel maternal glycemic indices during labor and the risk of significant neonatal hypoglycemia in T1DM

Abstract

While it is well accepted that glycemic control during pregnancy is important in order to reduce the risk for maternal and neonatal complications, the optimal management of blood glucose levels during labor and delivery is still a matter of controversy. This is especially true among women with type I diabetes mellitus (T1DM). Thus, the aim of our study was to determine if there is an association between maternal glucose control indices during labor and neonatal hypoglycemia. A historical prospective study pertaining 37 women with T1DM managed during pregnancy and delivery with an insulin pump and continuous glucose monitoring. Data regarding maternal glucose levels during active labor, pregnancy and neonatal outcome were collected. The relationship between maternal glucose control indices during active labor and neonatal hypoglycemia requiring IV glucose treatment was determined. The prevalence of neonatal hypoglycemia requiring IV dextrose was 40.5% (15/37). Maternal glucose variability indices during active labor were higher in mothers of neonates requiring IV dextrose than in mothers of neonates not requiring IV intervention (glucose standard deviation 25.5±13 vs. 14.7±6.7 mg/dL, respectively, p=0.007; maternal glucose IQR 37.3±24.3 vs. 21.6±10.7 mg/dl, respectively, p=0.03). For every 1 unit (1 mg/dl) increase in maternal glucose SD there was a 1.12 (CI 1.03-1.23, p= 0.01) greater odds for neonatal hypoglycemia requiring IV glucose treatment. This relationship persisted after adjustment for maternal age, pregestational BMI, gestational age at delivery, birth weight, and neonatal gender. In addition, maternal maximal glucose values were higher among infants requiring IV glucose (162.8±48.9 vs. 131.3±29.5 mg/dl respectively, p=0.03). Finally, there was a negative correlation between maternal maximum glucose value and neonatal lowest glucose value (p= 0.03, r= -0.34). Nonetheless, the mean and minimum maternal glucose values were not significantly different. To the best of our knowledge this is the first study to determent the association between intrapartum glucose variability indices and neonatal hypoglycemia in parturient with T1DM. There is a relationship between maternal glucose variability and excursions during active labor and risk for neonatal hypoglycemia requiring IV glucose treatment. These results highlight the clinical importance of tight glycemic control during labor in patients with T1DM.