Gestational diabetes mellitus: Metabolic control during labour

The purpose of this study was to assess, in women with gestational diabetes mellitus (GDM): 1) metabolic control during labour using a standardised pr otocol; 2) the influence of therapy during pregnancy in intrapartum metabol ic control and insulin requirements; and 3) the impact of maternal glycaemi a during labour on neonatal hypoglycaemia, An observational study of 85 wom en with GDM (54 insulin-treated) was performed. Intrapartum metabolic manag ement included i.v. glucose and insulin infusions, urinary ketone measureme nt and hourly capillary blood glucose (CBG) monitoring. Mean CBG from arriv al to delivery was 4.7+/-1.1 mmol/l with 83% of mean CBG values within the target range (2.8-6.9 mmol/l), Mean CBG and insulin requirements were unrel ated to therapy during pregnancy, but hypoglycaemia (CBG<2.8 mmol/l) was mo re frequent in women receiving insulin during pregnancy (40.7 vs 19.4%, p<0 .01). In several logistic regression models, CBG during labour was predicti ve of neonatal hypoglycaemia, We conclude that in women with GDM, the use o f a standardised intrapartum management protocol is associated to fair meta bolic control, that insulin requirements during labour are unrelated to the rapy during pregnancy and that high CBG during labour increases the risk of neonatal hypoglycaemia. Diab. Nutr. Metab. 13: 257-262, 2000. (C) 2000, Ed itrice Kurtis.