Intrapartum glycemic control and neonatal hypoglycemia in pregnancies complicated by diabetes

Abstract

Neonatal hypoglycemia is common following pregnancies complicated by diabetes. Current dogma suggests that tight intrapartum glycemic control decreases the risk of neonatal hypoglycemia by avoiding an acute rise in fetal insulin prior to delivery. This thesis reports on two studies that bring to question the association between intrapartum glycemic control and the risk of neonatal hypoglycemia. The first is a systematic review that highlights the paucity of high-quality evidence confirming an association between intrapartum glycemic control and neonatal hypoglycemia. The second is the largest cohort to date examining this relationship. It found that after adjustment for important neonatal confounders, in-target intrapartum glycemic control was not significantly associated with neonatal hypoglycemia. When taken as whole, these studies question current guidelines recommending tight intrapartum glycemic control and call for a randomized controlled trial of tight versus more relaxed glycemic targets during the labour and delivery period.