Oral Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2019

Is better peripartum glycaemic control in pre-existing diabetes linked to better outcomes? (#37)

Sarah Chalak 1 , Alexander Kim 1 , Tripti Joshi 1 , Leah Snape 1 , Margaret Layton 1 , Lili Yuen 1
  1. Department of Endocrinology, Gosford Hospital, GOSFORD, NSW, Australia

Introduction

The relationship between peripartum blood glucose levels (BGLs) and neonatal outcomes is unclear1. Our objective was to assess the association of optimised peripartum BGLs with neonatal outcomes in Type 1 diabetes (T1DIP) and Type 2 diabetes in pregnancy (T2DIP) within the Central Coast Local Health District (CCLHD).

Methods

Retrospective analysis of T1DIP and T2DIP presenting for antenatal care between 2014–2019 was conducted from available medical records. Peripartum BGLs within 24hrs of delivery were collected. Our intrapartum BGL target is 4-7mmol/L; an insulin infusion is commenced if BGLs >7mmol/L on two consecutive readings.

Results

Peripartum BGLs and neonatal outcome data for 30 T1DIP and 31 T2DIP were available.   Groups were divided into maternal peripartum average BGL > 7mmol/L (Group 1) and BGL <7mmol/L (Group 2). The average gestation at delivery was 36.8±2.39 weeks. Overall average maternal BGL over the 24 hours pre-delivery (in T1DIP and T2DIP) was 6.80±2.3 mmol/L and over the 6 hours pre-delivery was 6.69±2.6 mmol/L. The overall average neonatal BGL within 24 hours of birth was 2.08±1.3 mmol/L.

Group 1 were more likely to have peripartum steroids administered, (53.6% vs 19.4% in Group 2; p=0.006). Group 1 in the 24 hours pre-delivery were more likely to be treated with insulin infusion.

Rates of neonatal hypoglycaemia(NH)  in Group 1 vs Group 2 at 6hrs was 84.2% vs 63.4%; p=0.102 and at 24 hrs was 78.3% vs 64.9% ; p=0.271. Maternal maximum BGL >7mmol/L in the 6 hours pre-delivery were more likely to have babies with NH requiring parenteral therapies (80.8% vs 35%, p=0.014); this was also found in Group 1 24 hours pre-delivery (80.6%vs44%; p=0.011).

Group 1 neonates had high rates of respiratory distress (50.0 vs 19.6%, p=0.013) but lower rates of neonatal jaundice (26.8% vs 55.6%; p=0.034).

Conclusions

Rates of NH were not significantly different between the two groups. Peripartum maternal hyperglycaemia is associated with increased rates of respiratory distress and requiring parental treatment for NH.

 

  1. 1. Yamamoto JM, Benham J, Mohammad K, Donovan LE & Wood S. Intrapartum glycaemic control and neonatal hypoglycaemia in pregnancies complicated by diabetes: a systematic review. Diabetic Medicine. 2018; 35: 173-183.