Gestational Diabetes Clinical Trial
Official title:
Glucose Control During Labour in Gestational Diabetes Mellitus With Insulin Treatment: Insulin-Glucose-Infusion Versus Observational Approach - Is There a Difference in Neonatal Hypoglycemia Rate?
Pregnant women with gestational diabetes who are treated with insulin and their daily insulin dose is 30 IU or more will be randomized into two groups. Active treatment group will receive insulin-glucose-infusion during labour. In the observational group, blood glucose level during labour will be monitored and insulin-glucose-infusion is started only if needed. The hypothesis is that there will not be a difference in rate of hypoglycemia between the two groups and that the proportion of observational group participants that need infusion is low.
Intrapartum blood glucose level has negative correlation to neonatal blood glucose level in
type 1 diabetics. In gestational diabetes the correlation is less clear. In the view of
current knowledge, it seems that moderately elevated intrapartum blood glucose may not cause
neonatal hypoglycemia. There is no consensus of how to treat intrapartum blood glucose level
in gestational diabetics. Some studies have implied that most of mothers with gestational
diabetes would have normal blood glucose level during labour and hence would not need any
intervention if their daily insulin dosage is less than 0,5-1 IU/kg.
Study participants are recruited into the study at Tampere University Hospital Maternity Ward
when their daily insulin dose exceeds 30 IU. Randomization is done at 37th gestational week,
if vaginal delivery is planned, and HbA1c is measured. Randomization envelope is opened at
the delivery ward when active labour begins and treatment of blood glucose level is carried
out accordingly. If insulin dose is 1 IU/kg or more, the participant is treated as in active
treatment group despite of result of randomization. All neonates will receive milk substitute
after birth in labour ward. Plasma glucose is measured immediately if neonate has symptoms of
low blood sugar. If not, plasma glucose is measured approximately two hours after birth and
after that every 4 hours until plasma glucose is 3,0 mmol/l or more in three consecutive
measurements.
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