Antepartum and intra-partum insulin management of type 1 and type 2 diabetic women: Impact on clinically significant neonatal hypoglycemia

Abstract

Objective Assess efficacy of intrapartum intravenous (i.v.) insulin and effect of antepartum and intrapartum diabetic control on various measures of clinical neonatal hypoglycemia. Design Retrospective chart review. Setting Regional Diabetes in Pregnancy Clinic. Results Maternal hypoglycemia occurred intrapartum in 56% of subjects. Mean delivery blood glucose with intravenous insulin use was 6.7 mmol/l. Capillary blood glucose <2.2 mmol/l occurred in 69% of neonates and 44% received intravenous glucose. Maternal delivery glucose >6.5 mmol/l correlated with occurrence of neonatal glucose <2.2 mmol/l but not requirement for i.v. glucose or NICU admission. A third trimester HbA1c >6.5% had a stronger association with NICU admission and i.v. glucose requirement. Conclusions Blood glucose at delivery >6.5 mmol/l predicts neonatal hypoglycemia but does not correlate with severity. Chronic maternal hyperglycemia, reflected by pre-delivery HbA1c, predicts severe fetal hyperinsulinism and requirement for aggressive intervention. This stresses the importance of a target third trimester HbA1c of <6.5%.