Kelsey Pinson, Jane J Kim, Navyaa Sharma, Emily Kobayashi, Amit R Majithia, Valentina Stanley, Gladys A Ramos
Interstitial glucose greater than 120 mg/dL was common, and neither BMI nor gestational weight gain appears to have a significant clinical impact on glucose in labor. These data challenge contemporary definitions of glucose goals in labor, and further study is needed to better define glucose in labor and identify risk factors for adverse outcomes.
INTRODUCTION: Current recommendations for intrapartum glycemic control in those with diabetes mellitus are based upon expert opinion. Our objective was to characterize intrapartum interstitial glucose values using continuous glucose monitors (CGMs) in term gravidas without diabetes.
METHODS: A prospective observational cohort of 72 parturients without pre-gestational or gestational diabetes. CGMs were placed in early labor and the following were obtained: glucose at delivery, mean glucose in active and second stage of labor, time in range defined as 70-120 mg/dL, time above range, and time below range. Glucose parameters were compared by body mass index (BMI) and by adequacy of gestational weight gain. Neonatal outcomes were assessed.
RESULTS: The mean glucose value at delivery was 109 ± 27 mg/dL and over the 2 h prior to delivery was 99 ± 23 mg/dL. A total of 26% of parturients had a glucose value > 120 mg/dL at the time of delivery. Mean glucose in active labor was 101 ± 25 mg/dL and in the second stage was 99.5 ± 23 mg/dL. In labor, average time-in-range was 69.8% (10th-90th percentile 33.8%-95.8%), time-above-range was 19.9% (10th-90th percentile 0%-66.2%), and time-below-range was 10.3% (10th-90th percentile 0%-66%). Neither BMI nor gestational weight gain had a significant clinical impact on these parameters. A total of 28 infants had glucose checked for clinical indications and 5 required treatment for neonatal hypoglycemia; this was unrelated to mean glucose during labor or at delivery, time-above-range in labor and second stage, and time-above-range in the 4 h prior to delivery.
CONCLUSION: Interstitial glucose greater than 120 mg/dL was common, and neither BMI nor gestational weight gain appears to have a significant clinical impact on glucose in labor. These data challenge contemporary definitions of glucose goals in labor, and further study is needed to better define glucose in labor and identify risk factors for adverse outcomes.