Management of labour in pregnancy complicated by diabetes

Diabetes mellitus complicates <5% of all pregnancies in Pakistan, but is a major cause of perinatal morbidity and mortality, as well as maternal morbidity. Appropriate glycaemic control is not only important throughout pregnancy but is equally important during the intra-partum period. Increased blood glucose levels 4-6 hours prior to delivery increase the chances of hypoglycaemia in neonates. It is essential to optimize blood glucose levels during the intra-partum period as avoiding maternal hyperglycaemia will prevent foetal hyperglycaemia, and hence reduce the chances of neonatal hypoglycaemia and foetal acidaemia. Infants who develop neonatal hypoglycaemia, have a 2-3.5 times higher risk of developing neuro-developmental impairment on follow-up at 18 months to 7 years of age.