Intrapartum glycaemic control and neonatal hypoglycaemia in pregnancies complicated by diabetes: a systematic review. Issue 2 (14th January 2018)

• Record Type: Journal Article
• Authors: Yamamoto, J. M.; Benham, J.; Mohammad, K.; Donovan, L. E.; Wood, S.
• Is Part Of: Diabetic medicine. Volume 35:Issue 2(2018)
• Page Start: 173
• Page End: 183
• Publication Date: 2018-01-14
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13546
• Languages: English
• ISSNs: 0742-3071

Abstract

What's new?: This is the first rigorous systematic review assessing the impact of intrapartum glycaemic control on neonatal hypoglycaemia in pregnancies complicated by diabetes. We found that studies were discordant in finding an association between intrapartum maternal glucose and neonatal hypoglycaemia, with 12 of the 23 studies identified finding no significant association. We highlight the paucity of high‐quality evidence supporting an association between intrapartum glycaemic control and neonatal hypoglycaemia. Additional high‐quality studies are needed to determine whether tight intrapartum glycaemic control is superior to more relaxed glycaemic targets intrapartum for women with diabetes in pregnancy. Abstract: Aims: To examine whether, in neonates of mothers with Type 1, Type 2 and gestational diabetes, in‐target intrapartum glycaemic control was associated with a lower risk of neonatal hypoglycaemia compared with out‐of‐target glycaemic control. Methods: We searched PubMed and EMBASE for all available publications, regardless of year, based on a published protocol (PROSPERO CRD42016052439). Studies were excluded if they did not report original data or were animal studies. Data were extracted from published reports in duplicate using a prespecified data extraction form. The main outcome of interest was the association between in‐target intrapartum glycaemic control and neonatal hypoglycaemia. Results: We screened 2846 records for potential study inclusion; 23 studies, including approximately 2835 women with diabetes, were included in the systematic review. Only two of those studies specifically examined in‐target vs out‐of‐target intrapartum glycaemic control. Of the studies included, six showed a relationship between intrapartum glucose and neonatal hypoglycaemia, five others showed a relationship in at least one of the analyses performed and 12 did not find a significant relationship. Only one study was identified as having a low risk of bias. Conclusions: There is a paucity of high‐quality data supporting the association of glucose during labour and delivery with neonatal hypoglycaemia in pregnancies complicated by diabetes. Further studies are required to examine the impact of tight glycaemic targets in labour.