Diabetes Management at Time of Childbirth

Abstract

Dynamic changes occur in glucose handling as well as insulin sensitivity and pharmacokinetics at the time of childbirth in pregnancies complicated by diabetes. The unpredictable timing and nature of labour and childbirth contribute to intrapartum glycemic challenges. Furthermore, there is a lack of high-quality evidence in the literature to guide glycemic targets and management in the intrapartum period. This lack of high-quality evidence contributes to the controversies about optimum intrapartum glycaemic targets, and results in wide variations between hospital protocols for intrapartum glucose monitoring and management. Despite these controversies, women with diabetes, particularly those with type 1 diabetes, are vulnerable for the development of hypoglycemia and/or diabetic ketoacidosis if their intrapartum glycemia is not appropriately managed. 

An in-depth discussion of the timing of delivery in women with diabetes in pregnancy is beyond the scope of this article. Briefly, communication between diabetes and obstetrical care providers is encouraged to develop an individualized plan for the optimum timing of childbirth for women experiencing diabetes in pregnancy. This plan should be based on the glycemia achieved in pregnancy, the type of diabetes, and other risk factors for stillbirth such as maternal age, smoking status, the presence of retinopathy and fetal monitoring findings.