Evaluation of an intrapartum insulin regimen for women with diabetes

Annie M. Dude*, Charlotte Niznik, Alan M. Peaceman, Lynn M. Yee

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:To examine whether an insulin protocol for intrapartum glucose control among parturients with diabetes was associated with improved outcomes.METHODS:This is a retrospective cohort study of women with pregestational or gestational diabetes delivering a liveborn neonate at Northwestern Memorial Hospital. Before 2011, women with diabetes were given intravenous (IV) insulin or glucose during labor at the discretion of the on-call endocrinologist. In 2011, a standardized protocol was designed to titrate insulin and glucose infusions. Outcomes were compared between two time periods: January 2005-December 2010 (before implementation) and January 2012-December 2017 (after implementation) with 2011 excluded to account for a phase-in period. Maternal outcomes included intrapartum hyperglycemia (blood glucose greater than 125 mg/dL) and hypoglycemia (blood glucose less than 60 mg/dL). Neonatal outcomes included hypoglycemia (blood glucose less than 50 mg/dL), intensive care admission, and IV dextrose therapy. t tests, Wilcoxon rank sum tests, and χ2 tests were used for bivariable analyses. Linear and logistic multivariable regression were used to account for confounding factors.RESULTS:Of 3,689 women, 928 (25.2%) delivered before 2011. After protocol implementation, frequencies of both maternal intrapartum hyperglycemia (51.3% vs 37.9%) and hypoglycemia decreased (6.1% vs 2.5%), both P<.001; respective adjusted odds ratio [aOR] 0.64, 95% CI 0.54-0.77 and 0.50, 95% CI 0.33-0.78. The frequency of neonatal hypoglycemia, however, increased (36.6% vs 49.2%, P<.001; aOR 1.73, 95% CI 1.45-2.07). Admission to the neonatal intensive care unit and need for IV dextrose therapy were similar across time periods.CONCLUSION:A formal protocol to manage insulin and glucose infusions for parturients with diabetes was associated with improved intrapartum maternal glucose control, but an increased frequency of neonatal hypoglycemia.

Original languageEnglish (US)
Pages (from-to)411-416
Number of pages6
JournalObstetrics and gynecology
Volume136
Issue number2
DOIs
StatePublished - Aug 1 2020

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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