Mini Review - Journal of Labor and Childbirth (2023) Volume 6, Issue 3
Diabetes Management during Labor and Delivery
Andrea Ricci*
Department of Gynecology, Arden University of Berlin
Department of Gynecology, Arden University of Berlin
E-mail: ricci@adu.ac.gn
Received: 01-Jun-2023, Manuscript No. jlcb-23-102621; Editor assigned: 05-Jun-2023, Pre QC No. jlcb-23-102621(PQ); Reviewed: 19-Jun-2023, QC No. jlcb-23-102621; Revised: 22-Jun-2023, Manuscript No. jlcb-23-102621(R); Published: 29-Jun-2023, DOI: 10.37532/jlcb.2023.6 (2).01-04
Abstract
During labor, controlling hyperglycemia is essential to achieving better outcomes for both the mother and the baby. This is especially important for mothers with type 1 diabetes who are pregnancies and for all mothers who require insulin treatment during pregnancy. The management of hyperglycemia during the immediate antepartum period is made more difficult by the use of antenatal steroids in mothers at risk of preterm birth, which necessitates adjustments to insulin therapy’s dosage. During active labor, mothers are typically asked to be nil per orum. In the hours leading up to the baby’s birth, this necessitates proper management of fluid, glucose, and insulin. Patients still require glucose insulin infusions until they are able to eat and drink normally if the woman has an operative delivery. The management of hyperglycemia during labor and the immediate postpartum period is the primary focus of this review. Also discussed is a schedule for women taking steroids during the antepartum period. In women who are nil orally, the review suggests a practical glucose insulin regimen that can be followed during active labor. The review concludes with a discussion of these women’s immediate postpartum management.
Keywords
Hyperglycemia • Type 1 diabetes • Antepartum • Antenatal Steroids • Operative delivery • Postpartum period
Introduction
Women with gestational diabetes rarely require insulin during the early or late stages of pregnancy. With the delivery of the placenta comes an end to the need for insulin because there is less insulin resistance. The need for insulin during active labor in women with type 1 or type 2 diabetes before pregnancy decreases to some extent. The most important aspect of managing diabetes in the mother during labor is to avoid hyperglycemia, as this increases the risk of acidaemia and complications in the newborn as well as the risk of hypoglycemia in the newborn after delivery. This review focuses on the management of hyperglycemia during labor and the immediate postpartum period. After delivery of the placenta, insulin requirements drop to over 50% in type 1 diabetes and even further in type 2 diabetes mellitus [1].
Pregnancy Care
Timing and delivery method
Pregnant women with diabetes are typically delivered before term to reduce the risk of intrauterine death4. However, with better obstetric care or foetal monitoring, some diabetic pregnant women can be delivered before term. If a caesarean section is required, it should be scheduled at 38 weeks of gestation for pregnant women and infants who are in the normal growth curve (documented by serial ultrasounds). Women who have previously experienced a normal delivery should not be discouraged from attempting a vaginal birth because of their diabetes. A pre-anaesthetic assessment is required for all women who have been diagnosed with diabetes prior to elective or emergency operative delivery. Even if macrosomia is found on ultrasound findings, women should be encouraged to have a vaginal birth because it has more benefits than an operative intervention [2].
Use of pregnancy steroids
Due to the improved lung maturation of the preterm offspring, antenatal steroids reduce the risk of hyaline membrane disease and associated respiratory distress in mothers at risk for preterm delivery7. Glucocorticoids improve outcomes further by increasing lung surfactant production in the lungs of the developing baby. The foetal lung’s production of surfactant is reduced by insulin and hyperglycemia. Premature babies born to diabetic mothers experience a delay in lung maturation of approximately two weeks. A protocol that was developed by Prof. Donald Pearson at the Aberdeen Maternity Hospital and that we have been following in our patients is being shared.1Dexamethasone dosing; Day 1: Two 6 mg doses taken 12 hours apart on Day 2: Dosing of betamethasone in two 6 mg doses spaced 12 hours apart Day 1: Day 2 and 12 mg: 12 mg [3].
Handling of blood glucose during pregnancy
This strongly suggests that muscle contractionrelated glucose uptake in both uterine and skeletal muscles, independent of insulin, is the predominant determinant of glucose utilization during labor.10 The goal of intra-partum treatment for women with diabetes is first to maintain normoglycaemia to prevent neonatal hypoglycaemia.11 Second, in type 1 diabetes, insulin and glucose infusions are required to prevent metabolic de-compensation and ketogenesis during active labor or surgery when the patient is fasting.12 Target glucose values [4, 5].
In type 1 diabetes mellitus
During active labor and the caesarean section, diabetic women need insulin and dextrose. The objective is to maintain values of capillary glucose between 4 and 7 mmol/l (70 and 120 mg/dl). Continue regular glucose monitoring and insulin until the patient is asked to begin fasting in the event of elective induction of labor (IOL) or caesarean section. The night before the planned fast, reduce long-acting insulin by 50%. Beginning with an insulin-dextrose infusion in accordance with Table 2, begin fasting. Once the obstetrician or anesthesiologist determines that the patient will be kept on an empty stomach, insulin-dextrose infusion (Table 2) should be initiated in the event of an emergency caesarean section or spontaneous labor. The rate of insulin infusion should be decreased by 50% upon delivery of the placenta, and the insulin-dextrose infusion should continue until the first meal after birth [6, 7].
In type 2 diabetes mellitus
Patients with type 1 diabetes should maintain blood glucose targets between 4 and 7 mmol/L (70 and 120 mg/dl). During labor and surgery, some women with type 2 diabetes may require insulin. Avoid taking any oral medications, such as metformin, the evening before elective surgery or IOL. On the night before, basal insulin doses can be administered at half the usual dose [8]. When fasting begins, blood glucose levels should be checked every two hours, and if they are higher than 120 mg/dl, insulin-dextrose infusions should be started twice [9, 10].
Conclusion
At the time of delivery, the need for insulin is greatly reduced, and occasionally it may not be necessary for a few hours. In patients with type 1 diabetes, the planned postpartum dose of subcutaneous insulin that is administered with the first meal following delivery should be reduced by 50% shortly after the delivery of the placenta. Infusions of insulin and dextrose can be stopped 20 minutes after subcutaneous insulin is given. Patients with gestational diabetes and type 2 diabetes who require insulin dextrose infusions during labor can stop receiving them shortly after the placenta is delivered. Patients who did not require insulin during pregnancy are extremely unlikely to do so after giving birth.
References
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- Mimouni F, Miodovnik M, Siddiqi TA et al. Perinatal asphyxia in infants of insulin-dependent diabetic mothers. J Pediatr. 113, 345-353 (1988).
- Kline GA, Edwards A. Antepartum and intra-partum insulin management of type 1 and type 2 diabetic women: Impact on clinically significant neonatal hypoglycemia. Diabetes Res Clin Pract. 77, 223-230 (2007).
- Garabedian C, Deruelle P. Delivery (timing, route, peripartum glycemic control) in women with gestational diabetes mellitus. Diabetes Metab. 36, 515-521 (2010).
- Clinical Guideline; Diabetes in pregnancy management of diabetes and its complications from preconception to the postnatal period. 2015 National Institute of Clinical Excellence. (2018).
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- Roberts D, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 3, CD004454 (2006).
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