Watchful waiting: a management protocol for maternal glycaemia in the peripartum period

It is accepted that tight glycaemic control is necessary during labour in women with pregestational or gestational diabetes mellitus (GDM). Although policies vary, routine use of intravenous glucose and insulin remains a standard practice in some institutions. We present a retrospective review of a more conservative approach. Briefly, regardless of planned delivery method, maternal blood sugar level (BSL) is monitored during delivery and only if outside 4-7 mmol/L is action taken. We report the results of an audit of this practice.

A retrospective (August 2001-July 2004) review of 137 singleton, term deliveries of women with diabetes (23 pregestational, 114 GDM). Predetermined outcomes reported were BSL achieved prior to delivery, first neonatal BSL and/or admission to neonatal intensive care unit (NICU) for hypoglycaemia.

With our management practice, most women had a BSL between 4 and 8 mmol/L prior to delivery (17 (74%) diabetes mellitus (DM), 37 (93%) diet-controlled GDM, 55 (89%) insulin-requiring GDM). Neonatal hypoglycaemia (< 2.6 mmol/L) was common (n = 30 (22%)). However, most neonatal hypoglycaemia occurred in infants born to mothers with BSL 4-8 mmol/L (n = 26 (87%)). Neonatal hypoglycaemia requiring NICU admission (n = 13) was predominantly in infants born to mothers with BSL < 8mmol/L prior to delivery (n = 10 (77%)). Three of eight maternal BSLs > 8 mmol/L occurred prior to emergency caesarean section in women with pregestational diabetes.

These results suggest that our current practice, particularly in women with GDM, may offer an alternative to more aggressive regimes.