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Peripartum insulin rarely needed in gestational diabetes

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Most women with gestational diabetes do not require insulin while they’re giving birth, Spanish researchers report in the American Journal of Obstetrics and Gynecology published online on March 30th.

“Glycemic control during labor in gestational diabetes mellitus rarely requires insulin use and is unrelated to…treatment during gestation,” lead author Dr. Juana A. Flores-Le Roux told Reuters Health by email.

The study focused on 129 women with gestational diabetes who had been admitted for labor and delivery, according to Dr. Flores-Le Roux and colleagues at the Universitat Autonoma de Barcelona.

In 86%, maternal intrapartum capillary blood glucose fell to within the target range of 3.3 to 7.2 mmol/L without the need for use of insulin. There was no maternal hypoglycemia or severe ketosis.

Glucose levels above 7.2 mmol/L were significantly associated with third-trimester HbA1c levels and with noncompliance with endocrinology follow-up. They did not correlate with the treatment, either insulin or diet, established during pregnancy.

However, the risk of neonatal hypoglycemia was significantly greater in mothers using insulin during pregnancy compared to those on dietary control (60.5% versus 29.5%).

“Further studies will be required to establish the optimal glycemic target during labor that is associated with the best perinatal outcome,” the investigators conclude.

Am J Obstet Gynecol 2010.