Glycemic Control During Labor and Delivery

Key Points

  • 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.

    • Neonatal hypoglycemia is directly and inversely related to maternal hyperglycemia during labor. 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.

  • 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, pregnant women with diabetes have improved pregnancy outcomes and can progress to near term and safely have vaginal deliveries.

  • 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 women with gestational diabetes, insulin should be stopped with the onset of labor; sufficient glucose should be infused to keep the woman from becoming ketotic from the pronged period of starvation.

  • In women with type 1 diabetes or those with insulin-requiring type 2 diabetes, subcutaneous insulin should be stopped on the morning of an induction or at the onset of spontaneous labor.

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