Severe neonatal hypoglycaemia and intrapartum glycaemic control in pregnancies complicated by type 1, type 2 and gestational diabetes

J M Yamamoto, L E Donovan, K Mohammad, S L Wood, J M Yamamoto, L E Donovan, K Mohammad, S L Wood

Abstract

Aims: To determine if in-target intrapartum glucose control is associated with neonatal hypoglycaemia in women with type 1, type 2 or gestational diabetes.

Methods: This was a retrospective cohort study of pregnant women with diabetes and their neonates. The primary exposure was in-target glucose control, defined as all capillary glucose values within the range 3.5-6.5 mmol/l during the intrapartum period. The primary outcome, neonatal hypoglycaemia, was defined as treatment with intravenous dextrose therapy. Multiple logistic regression was used to examine the association between maternal intrapartum glycaemic control and neonatal hypoglycaemia, adjusting for covariates.

Results: Intrapartum glucose testing was available for 157 (86.3%), 267 (76.3%) and 3256 (52.4%) women with type 1, type 2 and gestational diabetes, respectively. In the univariate analysis, in-target glycaemic control was significantly associated with neonatal hypoglycaemia in women with gestational diabetes, but not in women with type 1 or 2 diabetes. However, after adjustment for important neonatal factors (large for gestational age, preterm delivery and infant sex), intrapartum in-target glycaemic control was not significantly associated with neonatal hypoglycaemia in women regardless of diabetes type [adjusted odds ratios 0.4 (95% CI 0.1, 1.4), 0.7 (95% CI 0.3, 1.3) and 0.7 (95% CI 0.5, 1.0) for women with type 1, type 2 and gestational diabetes, respectively].

Conclusions: There was no significant association between in-target glycaemic control and neonatal hypoglycaemia after adjustment for neonatal factors. Given the high risk of maternal hypoglycaemia and the resources required, future trials should consider whether more relaxed intrapartum glycaemic targets may be safer and yield similar neonatal outcomes.

© 2019 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Figures

Figure 1
Figure 1
Flow diagram of mother–infant pairs included in the study cohort. APHP, Alberta Perinatal Health Program.

References

    1. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract 2014; 103: 176–185.
    1. Murphy HR, Bell R, Cartwright C, Curnow P, Maresh M, Morgan M et al Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic‐to‐clinic variations: a prospective nationwide study. Diabetologia 2017; 60: 1668–1677.
    1. Evers IM, de Valk HW, Visser GH. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ 2004; 328: 915.
    1. Metzger BE, Persson B, Lowe LP, Dyer AR, Cruickshank JK, Deerochanawong C et al Hyperglycemia and adverse pregnancy outcome study: neonatal glycemia. Pediatrics 2010; 126: e1545–e1552.
    1. Yamamoto JM, Kallas‐Koeman MM, Butalia S, Lodha AK, Donovan LE. Large‐for‐gestational‐age (LGA) neonate predicts a 2.5‐fold increased odds of neonatal hypoglycaemia in women with type 1 diabetes. Diabetes Metab Res Rev 2017; 33 10.1002/dmrr.2824. Epub 2016 Jun 21.
    1. Feig DS, Donovan LE, Corcoy R, Murphy KE, Amiel SA, Hunt KF et al Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet 2017; 390: 2347–2359.
    1. Screening guidelines for newborns at risk for low blood glucose. Paediatr Child Health 2004; 9: 723–740.
    1. Diabetes Canada Clinical Practice Guidelines Expert Committee , Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and pregnancy. Can J Diabetes 2018; 42 Suppl 1: S255–S282.
    1. Dashora U, Murphy HR, Temple RC, Stanley KP, Castro E, George S et al Managing hyperglycaemia during antenatal steroid administration, labour and birth in pregnant women with diabetes. Diabet Med 2018; 35: 1005–1010.
    1. Yamamoto JM, Corcoy R, Donovan LE, Stewart ZA, Tomlinson G, Beardsall K et al Maternal glycaemic control and risk of neonatal hypoglycaemia in Type 1 diabetes pregnancy: a secondary analysis of the CONCEPTT trial. Diabet Med 2019; 36: 1046–1053.
    1. Yamamoto JM, Benham J, Mohammad K, Donovan LE, Wood S. Intrapartum glycaemic control and neonatal hypoglycaemia in pregnancies complicated by diabetes: a systematic review. Diabet Med 2018; 35: 173–183.
    1. Statistics Canada . Census Profile, 2016 Census. Calgary, Alberta: Available at Last accessed 6 March 2019.
    1. Alberta Health Services , Calgary Zone. IV insulin Labour Drip. 2016. Calgary, Alberta: Alberta Health Services.
    1. Alberta Health Services , Calgary Zone. Practice Support Document Guidelines. Blood Glucose Monitoring and Feeding of Infants at Risk for Hypoglycemia. 2015. Calgary, Alberta: Alberta Health Services.
    1. Thompson D, Capes S, Feig D, Kader T, Keely E, Kozak S. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada - Diabetes in pregnancy. Can J Diabetes 2008; 32: S168–S180.
    1. Stewart ZA, Yamamoto JM, Wilinska ME, Hartnell S, Farrington C, Hovorka R et al Adaptability of closed loop during labor, delivery, and postpartum: a secondary analysis of data from two randomized crossover trials in type 1 diabetes pregnancy. Diabetes Technol Ther 2018; 20: 501–505.
    1. Stewart ZA, Thomson L, Murphy HR, Beardsall K. A feasibility study of paired continuous glucose monitoring intrapartum and in the newborn in pregnancies complicated by type 1 diabetes. Diabetes Technol Ther 2019; 21: 20–27.
    1. Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M et al A new and improved population‐based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108: E35.
    1. Rowe CW, Putt E, Brentnall O, Gebuehr A, Allabyrne J, Woods A et al An intravenous insulin protocol designed for pregnancy reduces neonatal hypoglycaemia following betamethasone administration in women with gestational diabetes. Diabet Med 2019; 36: 228–236.
    1. Joshi T, Oldmeadow C, Attia J, Wynne K. The duration of intrapartum maternal hyperglycaemia predicts neonatal hypoglycaemia in women with pre‐existing diabetes. Diabet Med 2017; 34: 725–731.
    1. Maresh MJ, Holmes VA, Patterson CC, Young IS, Pearson DW, Walker JD et al Glycemic targets in the second and third trimester of pregnancy for women with type 1 diabetes. Diabetes Care 2015; 38: 34–42.
    1. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B et al A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361: 1339–1348.
    1. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS et al Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477–2486.
    1. Harris DL, Weston PJ, Signal M, Chase JG, Harding JE. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double‐blind, placebo‐controlled trial. Lancet 2013; 382: 2077–2083.
    1. Kline GA, Edwards A. Antepartum and intra‐partum insulin management of type 1 and type 2 diabetic women: impact on clinically significant neonatal hypoglycemia. Diabetes Res Clin Pract 2007; 77: 223–230.
    1. Drever E, Tomlinson G, Bai AD, Feig DS. Insulin pump use compared with intravenous insulin during labour and delivery: the INSPIRED observational cohort study. Diabet Med 2016; 33: 1253–1259.
    1. Farrant MT, Williamson K, Battin M, Hague WM, Rowan JA. The use of dextrose/insulin infusions during labour and delivery in women with gestational diabetes mellitus: is there any point? Aust N Z J Obstet Gynaecol 2017; 57: 378–380.

Source: PubMed

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