RCT: Does Intrapartum Continuous Subcutaneous vs Intravenous Insulin Infusion Affect Neonatal Glycemic Outcomes?
BACKGROUND AND PURPOSE:
Wilkie et al. (AJOG, 2023) compared the effect on neonatal blood glucose levels of continuous subcutaneous insulin infusion (CSII) vs IV insulin infusion (IV) during labor and delivery among pregnant individuals with type 1 diabetes mellitus
Randomized controlled trial
Pregnant individuals with type 1 diabetes
Currently managed with CSII
Exclusions included: Altered state of consciousness intrapartum | Critically ill requiring ICU | At risk for suicide | Ketoacidosis on admission for delivery | IUFD | Fetal anomalies | Unable to partake in own care
IV insulin infusion
Patients randomized during antepartum visit
Upon admission for labor, interventions initiated as per protocol
First neonatal blood glucose level
IV: 35 participants | CSII: 35 participants
There was no statistically significant difference in the first neonatal glucose measurement between the groups (P=0.86)
IV: 49.2 (SD, 22.6) mg/dL
CSII: 50.1 (SD, 23.4) mg/dL
Neonates that required treatment oral and/or IV treatment for hypoglycemia
IV: 51.4% | CSII: 57.1%
Neonates requiring IV treatment for hypoglycemia: 28.6% in both groups
There was no difference in neonatal glycemic outcomes when patients with type 1 diabetes received either continuous subcutaneous insulin infusion or intravenous insulin infusion following admission in labor
The authors state
This study has significant clinical implications for clinical care given that it highlights that continuation of CSII is a comparable alternative to IV insulin infusions for intrapartum glycemic control, with no difference in neonatal outcomes
If providers and patients are comfortable with this approach, it represents an intrapartum clinical option for patients with T1DM
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