A standardized protocol to achieve normoglycaemia during labour and delivery in women with type 1 diabetes

Aim. - To evaluate a standardized protocol for maintaining near-normoglycaemia during labour and delivery in women with type 1 diabetes. Methods. - Over a nine-year period (1997-2005), 229 pregnancies in 174 women with type 1 diabetes were delivered at one centre. The same regimen was used for the induction of labour (group 1) and in women admitted in spontaneous labour (group 2): 10% dextrose (80 ml/h) intravenous was given along with short-acting insulin, starting at 1 IU/h intravenous via an infusion pump. Capillary blood glucose (CBG) was determined hourly, and the insulin infusion rate was modified accordingly. Results. - Labour was induced in 85 cases (37%) and spontaneous in 23 cases (10%), and an elective C-section was performed in 121 cases (53%). Maternal glycaemia during labour was 6.1 +/- 1.6 (range: 3.9-9.2) mmol/l in group 1, and 6.9 +/- 2.0 (range: 4.7-12.0) mmol/l in group 2. Maternal glycaemia at delivery was 5.8 +/- 1.5 (range: 3.4-9.4) and 6.3 +/- 1.9 (range: 4.1-11.4) mmol/l in groups 1 and 2, respectively. Women who underwent an elective C-section were not included in the standardized protocol and had higher glycaemia at delivery 7.1 +/- 2.0 (range: 2.7-13.5) mmol/l. Neonatal hypoglycaemia occurred in 30 infants (13%), and was only associated with preterm delivery. Conclusion. - Using a standardized simple protocol during labour, maternal glycaemia was maintained within a near-normal range in 80-85% of cases. (C) 2007 Elsevier Masson SAS. All rights reserved.