Glycaemic control in labour with diabetes: GILD, a scoping study

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Clinical Trial Design

Background:

• Diabetes in pregnancy affects 5-10% of pregnancies.
• Poor intrapartum glycemic control is linked to adverse neonatal outcomes.
• Current tight glucose control is burdensome and may not always be necessary.

Purpose of the Study:

• To assess the feasibility of a randomized clinical trial.
• To compare permissive versus intensive intrapartum glycemic control in pregnancies with diabetes.
• To evaluate clinical and cost-effectiveness.

Main Methods:

• Mixed-methods study including guideline audits, surveys, and service evaluation.
• Development of a non-inferiority umbrella trial protocol.
• Qualitative interviews to assess trial acceptability.

Main Results:

• Significant variation exists in current clinical practices for intrapartum glucose management.
• 66% of surveyed women expressed willingness to participate in a future trial.
• A feasible and acceptable umbrella trial design was developed.

Conclusions:

• An umbrella trial comparing permissive and intensive glycemic control is feasible and acceptable.
• This approach addresses the need for optimal intrapartum glucose management in diabetic pregnancies.
• Further research is recommended with an internal pilot phase.