Approaches & Tools

Does Glycemic Control Matter During Labor and Delivery?

In this section you will find:

• Slide Presentation - including specific treatment regimens for labor and delivery, a protocol for diabetic women treated with multiple injections of insulin, and a protocol for diabetic women treated with an insulin infusion pump
• Insulin Dosage Regimen for Diabetic Pregnancy - For insulin treatment throughout pregnancy to assure the best possible care of our pregnant diabetic women
• Reference list with notation of recommended Key Readings

Key Points:

• Outcomes in pregnancies complicated by diabetes are directly dependent on the degree of glucose control of the mother throughout the pregnancy
• With normoglycemic outpatient protocols, diabetic pregnant women have improved pregnancy outcomes and can progress to near term and safely have vaginal deliveries
• Neonatal hypoglycemia is directly related to maternal hyperglycemia during labor
• Protocols for maintaining normoglycemia during labor and delivery are necessary to achieve optimal results
• Labor’s effect to lower glucose is equivalent to prolonged exercise
• In insulin-requiring gestational diabetic women, no more insulin need be administered with the onset of labor; sufficient glucose should be infused to keep the women from becoming ketotic from the pronged period of starvation
• Type 1, insulin-dependent, diabetic women require no more subcutaneous insulin on the morning of an induction or at the onset of spontaneous labor

Finally:

The last 18 hours in utero have a significant impact on the infant’s metabolic responses after birth, even if maternal glucose control is adequate over the duration of gestation.  Hypoglycemia in the newborn is proportional to the hyperglycemia in the mother prior to delivery.  With maternal hyperglycemia, the compensatory fetal hyperinsulinemia will result in hypoglycemia upon cutting of the umbilical cord, since the source of incoming glucose will no longer be present.  With maintenance of normal glucose levels throughout labor and delivery in pregnancies that have been well-controlled throughout pregnancy, the neonate then has a normal metabolic response.