Comparison of intrapartum glycemic management strategies in pregnant women with type 1 diabetes mellitus

Abstract

Background Achieving intrapartum maternal euglycemia in women with type 1 diabetes mellitus (T1DM) is critical to reducing the risk of neonatal hypoglycemia. Objective This study sought to compare the maternal and neonatal outcomes among women with T1DM by different intrapartum glycemic control strategies of continuation of subcutaneous insulin pumps versus intravenous insulin infusion. Methods A retrospective cohort study was performed to identify all women with type 1 diabetes mellitus in pregnancy between 1 October 2017 and 1 August 2020 at our tertiary medical center. Medical records were reviewed for sociodemographic, clinical characteristics, and perinatal outcomes. A composite neonatal outcome was created to include one or more of the following outcomes: 5-minute APGAR less than 7, neonatal intensive care unit admission, neonatal hypoglycemia, or respiratory distress. Results We identified 75 women with T1DM that met inclusion criteria, 27(36%) who remained on their subcutaneous insulin pump and 48(64%) who were transitioned to intravenous insulin infusion intrapartum. Women that continued subcutaneous insulin were more likely to be older (30.5 vs. 28.1, p = .04), multiparous (74% vs. 50%, p = .042), and have a continuous glucose monitor (CGM) (93% vs. 43%, p < .001). There was no difference in maternal hypoglycemic events (14.8% vs. 18.8%, p = .76) or severe hyperglycemia (greater than 250 mg/dL)/development of diabetic ketoacidosis (3.7% vs. 4.2%, p = .99) in labor between both groups. There was no difference in neonatal composite outcome when adjusted for gestational age at delivery, maternal age, parity, and CGM use for both groups (aOR 0.73, 95% CI 0.12–4.43, p = .728). Conclusion Continuation of subcutaneous insulin in the intrapartum period appears to be a reasonable option in women with T1DM, however future, larger studies are needed to confirm this. Both patient and provider must be comfortable with this intrapartum strategy for effective glycemic control.