Permissive intrapartum glucose control: an equivalence randomized control trial (PERMIT)

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Neonatal Medicine

Background:

• Limited high-quality data exists on optimal maternal blood glucose management during labor.
• Current practices for intrapartum glycemic control in laboring individuals with diabetes vary.

Purpose of the Study:

• To compare permissive maternal blood glucose management (target 70-180 mg/dL) with usual care (target 70-110 mg/dL) in laboring individuals with diabetes.
• To assess the impact of different glycemic targets on neonatal blood glucose levels.

Main Methods:

• A two-site equivalence randomized controlled trial involving laboring individuals with pregestational or gestational diabetes at ≥34 weeks gestation.
• Participants were randomized to either usual care or permissive care, with maternal blood glucose monitored regularly.
• Insulin drips were administered if blood glucose exceeded the upper limit of the assigned target.

Main Results:

• Equivalence in the primary outcome (first neonatal heel stick glucose within 2 hours of birth) was observed between the usual care and permissive care groups (57.9 vs 57.1 mg/dL).
• 17% of participants in the usual care group required an insulin drip, compared to none in the permissive care group.
• Neonatal hypoglycemia rates were similar between groups (25% usual care vs 29% permissive care), with no significant differences in other neonatal or maternal outcomes.

Conclusions:

• Permissive intrapartum maternal blood glucose management is associated with equivalent neonatal blood glucose levels compared to usual care.
• This approach may reduce the need for insulin drips during labor for individuals with diabetes.
• Further research can explore long-term outcomes and refine best practices for intrapartum glycemic control.