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:
●(See "Pregestational diabetes mellitus: Prenatal glycemic control".)
●(See "Pregestational diabetes mellitus: Obstetrical issues and management".)