Poster Session 4
Category: Diabetes
Poster Session 4
Gali Garmi, MD
EMEK MEDICAL CENTER
AFULA, HaZafon, Israel
Mais Abu Nofal, MD
Maternal Fetal Medicine Division, Ontario Fetal Center, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
Toronto, Ontario, Canada
Noah Zafran, MBA, MD (she/her/hers)
Department of Obstetrics and Gynecology
Emek Medical Center
Afula, HaZafon, Israel
Rana Abboud, MD
Holy Family Hospital
Nazareth, HaZafon, Israel
Rula Iskander, MD
Resident
Emek Medical Center
Afula, HaZafon, Israel
Moran Levy, RN
Emek Medical Center
Afula, HaZafon, Israel
Hanna Armaly, RN
Holy Family Hospital
Nazareth, HaZafon, Israel
Raed Salim, MD
Chair
Holy Family Hospital
Nazareth, HaZafon, Israel
There is currently no consensus on the optimal intrapartum protocol for maintaining maternal euglycemia and preventing neonatal hypoglycemia in diabetic pregnant women. We aimed to compare two intrapartum glycemic control protocols in terms of their impact on the incidence of neonatal hypoglycemia.
Study Design:
A two-site randomized controlled trial was conducted between October 2017 and July 2025. Diabetic women (pregestational or gestational) in labor with viable, singleton, term pregnancy were randomly allocated to one of two treatment protocols at a 1:1 ratio. Group 1 received an intravenous infusion of 0.9% saline and 5% glucose, along with a continuous insulin infusion. Group 2, received a similar infusion without insulin. Maternal glucose levels were monitored every 1-2 hours and both groups received additional insulin drip if glucose levels exceeded 100mg/dL. Randomization was stratified by delivery site. The primary outcome was neonatal hypoglycemia defined as a glucose level < 40mg/dL. A total of 182 participants were required based on sample size calculation. The protocol was approved by the local IRBs and registered on September 2017 (ClinicalTrials.gov: NCT03273881). All participants provided informed consent.
Results:
Overall, 182 women were randomized; 93 in Group 1 and 89 in Group 2. Baseline demographic and obstetric variables including pregestational BMI, weight gain during pregnancy, diabetes type, and rates of immediate postpartum breastfeeding were comparable between groups. No neonate in either group had a cord blood glucose level < 40mg/dL. Neonatal hypoglycemia assessed from the first neonatal heelstick glucose level within the first 2 hours of birth occurred in 3 neonates (3.2%) in Group 1 and none (0%) in Group 2 (p=0.25). Mean intrapartum maternal blood glucose levels, rates of cesarean delivery, macrosomia, Apgar score < 7 at 5 min, and cord artery pH < 7.1 were similar across both groups.
Conclusion:
The incidence of neonatal hypoglycemia was low and did not differ significantly between the two intrapartum glycemic control protocols.