Pregestational and gestational diabetes: Intrapartum and postpartum glycemic control
- Siri L Kjos, MD
Siri L Kjos, MD
- Director of Perinatalogy
- WellHealth Quality Care
- Section Editors
- Michael F Greene, MD
Michael F Greene, MD
- Section Editor — Diabetes in Pregnancy
- Professor of Obstetrics and Gynecology
- Harvard Medical School
- David M Nathan, MD
David M Nathan, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- Harvard Medical School
In pregnancies complicated by diabetes mellitus, a key therapeutic goal across gestation is avoidance of maternal hyperglycemia, which increases the risk of several pregnancy-specific adverse events (see "Pregestational diabetes: Preconception counseling, evaluation, and management"). Good glycemic control remains important intrapartum because maternal hyperglycemia during labor increases the risk of fetal acidemia and neonatal hypoglycemia . Avoidance of hyperglycemia is less critical postpartum, but concern about maternal hypoglycemia increases because of large and rapid changes in maternal hormone concentrations after delivery of the placenta.
It should be noted that intrapartum maternal normoglycemia will not reduce the risk of neonatal hypoglycemia in women with poor antepartum glycemic control, since fetal pancreatic hyperplasia and excessive in utero insulin secretion have been established in response to prolonged exposure to hyperglycemia. These neonates are at risk of developing severe and prolonged hypoglycemia. (See "Neonatal hypoglycemia", section on 'Increased glucose utilization due to hyperinsulinism'.)
This topic will discuss intrapartum and postpartum glycemic control of women with pregestational and gestational diabetes. Other important issues in the management of these women are reviewed separately:
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- INTRAPARTUM ISSUES
- Intrapartum glucose and insulin requirements
- - Latent phase metabolic demands
- - Active phase metabolic demands
- Glucose monitoring
- - Intrapartum glucose targets
- - Intrapartum glucose monitoring
- Guidelines for glucose/insulin management
- - Women on a continuous subcutaneous insulin pump antepartum
- SPECIAL SITUATIONS
- Scheduled cesarean delivery
- Induction of labor
- POSTPARTUM MANAGEMENT
- Immediate postpartum period
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS