Relationship of glycaemic level of mother in last two hours before delivery and occurrence of acute neonatal complications

Georgy Joy Eralil

Abstract


Background: Diabetes is the most common pre-existing medical disorder seen in pregnancy. Between 2-5% of pregnancies are complicated by diabetes. 87.5% of these women have gestational diabetes, 7.5% have type 1 and 5% have type 2. The study was designed to know the relation of control of diabetes to neonatal outcome in terms of metabolic complications.

Methods: Study was conducted in laboring women in government medical college hospital Kottayam. Selection criteria was based on oral GTT. Patients with multiple gestations, other medical disorders were excluded. All the patients were monitored with hourly RBS in active phase of labor. It was compared with cord levels of RBS, calcium, haematocrit and admission to SCNU. For data measured at normal level Chi square test was used to study the significance of difference between the groups. For statistically significant differences odds ratios were computed and 95% confidence limits are calculated. Whenever necessary for quantitative data t- test was used to study the difference in mean values.

Results: All normal RBS had live births and all the intrauterine deaths were associated with maternal hyperglycaemia. Among the SCNU admission 87.5% had hyperglycaemia in mother. 33.3 % of abnormal RBS had admission to SCNU whereas only 3.4% of the normal RBS group had admission. The risk of SCNU admission is 14 times more among babies of mothers with abnormal maternal RBS. X2 = 16.188 P = 0.000. The correlation coefficient between maternal RBS and cord RBS is 0.35 indicating a negative relationship between maternal RBS and Cord RBS. The coefficient of determination (r2) is 12 indicates 12% of variation of RBS is explained by maternal RBS. The average RBs cord among mothers with abnormal maternal RBS is 58.4 and among mothers with normal RBS is 72.4 and the observed difference is statistically significant.

Conclusions: Heart The study shows that tight regulation of maternal glucose levels during labor can reduce the incidence of neonatal hypoglycaemia and is needed for best neonatal outcome. 


Keywords


GDM, Hypoglycaemia, RBS, Hypocalcaemia, Oral glucose tolerance test, Neonatal outcome

Full Text:

PDF

References


V. Rosenberg, G. Eglinton, E. Rauch, D. Skupski. Intrapartum maternal glycemic control in women with insulin requiring diabetes a randomized clinical trial of rotating fluids versus insulin drip. Am J Obstet Gynaecol. 2006;195:1095-9.

A. Jamal, N. Choobak, F. Tabassomi. Intrapartum maternal glucose infusion and fetal acid base status. Int J Gynaecol Obstet. 2007;97:187-9.

Rosenberg, Victor A, Eglinton, Gary S, Eden R, Skupski, et al. Intrapartum maternal glycaemic control in women with insulin requiring diabetes: a randomized clinical trial of rotating fluids versus insulin drip. Obstet Gynaecol Surv. 2007 Mar;62(3):159-61.

J. Mendiola, L. J. Grylack, J. W. Scanlon. Effects of intrapartum maternal glucose infusion on the normal foetus and newborn. Anaesth Analg. 1982 Jan;61(1):32-5.

Jovanovic L, Peterson CM. Insulin and glucose requirements during first stage of labor in insulin dependent diabetic women. Am J Med. 1983;75:607.

Gajjar F, Maitra NK. Intrapartum and perinatal outcomes in women with gestational diabetes and mild gestational hyperglycaemia. J Obstet Gynaecol India. 2005;55:135-7.

Curet LB, Izquierdo LA, Gilson GJ, Schneider JM, Perelman R, Converse J. Relative effects of antepartum and intrapartum maternal blood glucose levels on the incidence of neonatal hypoglycaemia. J Perinatol. 1997 Mar-Apr;17(2):113-5.