(1283) intrapartum Glucose Monitoring for A1GDM: A Randomized Controlled Trial

The objective of this study is to assess the effect of differing intrapartum(IP) glucose monitoring protocols on initial neonatal(neo) blood glucose(BG) level in pregnancies complicated by GDMA1.

Study Design:

This was a randomized controlled trial of pregnant individuals with singleton gestations and well controlled GDMA1 attempting a vaginal delivery. Written consent obtained and patients were randomly allocated to one of two IP glucose monitoring protocols: Infrequent group(IN) had a single BG measurement on admission vs the frequent group(FR) had BG measured every 4hours(hrs) in latent labor, and every 2hrs in active labor. Exclusion criteria: multiple gestation, non-compliance, poor glucose control, and/or diabetic fetopathy. The primary outcome was the first neo BG value after delivery. A total of 74 patients were necessary to have 80% power to detect a mean difference of 10mg/dL in glucose values between the two groups. Secondary outcomes included neo BG in the first 24 hrs and neo composite consisting of neo hypoglycemia(HG), NICU admission, shoulder dystocia, and APGAR score at 1min less than 5.

Results:

From 12/2024 to 5/2025 patients with well controlled GDMA1 were randomized(50 per group). Baseline characteristics of the two groups were comparable(table1). The primary outcome of the first neo BG after delivery was similar between the IN and FR group. The average blood glucose at delivery was 59.5mg/dL(IN) vs 58.5mg/dL(FR) with the mean difference non-significant (–1.0 mg/dL; 95% CI: –8.3 to 6.8; p = 0.78). At 24hrs of life, the mean BG level remained statistically non-significant, with mean difference of –3.5 mg/dL (95% CI: –8.8 to 1.8;p=0.20). The incidence of neo HG was similar between the IN and FR groups, 22% vs 26%,(OR 0.92; 95% CI: 0.34 to 2.48;p=0.87). Composite neo adverse outcome was not statistically significant between the groups(OR 1.52; 95% CI: 0.62 to 3.73;p = 0.36).

Conclusion:

Our study suggests reducing the frequency of BG monitoring in well controlled GDMA1 patients to an initial value on admission, is acceptable and not associated with an increased risk of neo morbidity.