Watchful waiting: a management protocol for maternal glycaemia in the peripartum period.

BACKGROUND: It is accepted that tight glycaemic control is necessary during labour in women with pregestational or gestational diabetes mellitus (GDM). Although policies vary, routine use of intravenous glucose and insulin remains a standard practice in some institutions. We present a retrospective review of a more conservative approach. Briefly, regardless of planned delivery method, maternal blood sugar level (BSL) is monitored during delivery and only if outside 4-7 mmol/L is action taken. We report the results of an audit of this practice.

METHODS: A retrospective (August 2001-July 2004) review of 137 singleton, term deliveries of women with diabetes (23 pregestational, 114 GDM). Predetermined outcomes reported were BSL achieved prior to delivery, first neonatal BSL and/or admission to neonatal intensive care unit (NICU) for hypoglycaemia.

RESULTS: With our management practice, most women had a BSL between 4 and 8 mmol/L prior to delivery (17 (74%) diabetes mellitus (DM), 37 (93%) diet-controlled GDM, 55 (89%) insulin-requiring GDM). Neonatal hypoglycaemia (< 2.6 mmol/L) was common (n = 30 (22%)). However, most neonatal hypoglycaemia occurred in infants born to mothers with BSL 4-8 mmol/L (n = 26 (87%)). Neonatal hypoglycaemia requiring NICU admission (n = 13) was predominantly in infants born to mothers with BSL < 8mmol/L prior to delivery (n = 10 (77%)). Three of eight maternal BSLs > 8 mmol/L occurred prior to emergency caesarean section in women with pregestational diabetes.

CONCLUSION: These results suggest that our current practice, particularly in women with GDM, may offer an alternative to more aggressive regimes.