Tight intrapartum maternal glucose control in pregestational diabetes is recommended to reduce the risk of neonatal hypoglycemia and neonatal intensive care unit (NICU) admission. Minimal evidence supports the relationship between intrapartum maternal glycemic control and neonatal hypoglycemia. The objective of the study is to compare the incidence of neonatal hypoglycemia with well-controlled blood glucose versus elevated glucose immediately prior to delivery in mothers with pregestational diabetes. This is a single-site, retrospective cohort study of singleton births with maternal pregestational diabetes from 1/2017-6/2019. Pre-delivery maternal glucose was defined as elevated if >110 mg/dL. The primary outcome was neonatal hypoglycemia (defined as < 45 mg/dL) within one hour of life. Secondary neonatal outcomes included neonatal hypoglycemia within 24 hours of birth, lowest neonatal glucose within 24 hours, and NICU admission. 164 deliveries were included; 59% had Type I diabetes (T1DM) and 42% had Type II diabetes (T2DM). Maternal pre-delivery glucose was elevated in 34% of all deliveries and similar by diabetes type. Incidence of neonatal hypoglycemia within 1 hr of birth in those with elevated glucose was similar to those with normal glucose (Table 1). NICU admissions were more frequent in the elevated maternal glucose group, but this was not statistically significant. Among those with elevated pre-delivery glucose, T1DM was associated with higher rates of neonatal hypoglycemia compared to T2DM, (68% vs. 41%, p=0.048, Table 2). Normal pre-delivery maternal glucose did not reduce the incidence of neonatal hypoglycemia compared to elevated glucose in women with pregestational diabetes. T1DM was associated with higher neonatal hypoglycemia rates regardless of pre-delivery maternal glucose control. Our results add to growing evidence that intrapartum glucose control may not be associated with a lower risk of neonatal hypoglycemia or NICU admissions. This supports the need to identify other interventions to reduce morbidity for infants of mothers with diabetes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)