(950) Maternal and neonatal outcomes of implementation of a computer-based software for intrapartum glucose management

The objective of the present study was to determine whether rates of neonatal hypoglycemia and maternal glucose levels differed among patients managed with conventional insulin dose calculation versus Glucommander insulin management software.

Study Design:

Outcomes pre- and post-implementation of Glucommander were analyzed. Inclusion criteria included type 1, type 2, or gestational diabetes, prenatal care at our center after 26 weeks of gestation, and vaginal delivery. Maternal characteristics including age, body mass index, type of diabetes, and third trimester treatment were obtained. Percentages of values in euglycemic (100-140 mg/dL), target (70-110 mg/dL pre- / 100-140 mg/dL post-intervention), hypoglycemic (less than 70 mg/dL), and hyperglycemic (greater than 140 or 180 mg/dL) ranges were calculated. Neonatal data points used in analysis included gestational age at delivery, delivery weight, initial neonatal glucose reading, and neonatal intensive care admission. Analyses included t-test and Chi-square.

Results:

108 pregnancies met inclusion criteria in pre-intervention group and 39 in post-intervention group. Summary of findings is presented in table 1. Total time in target glycemic range and rates of maternal hyperglycemia were similar between groups. Severe neonatal hypoglycemia was significantly less common among patients managed with Glucommander (p=0.034) with no difference in NICU admissions for hypoglycemia. In sub-analyses of pre-term and term deliveries, greater incidence of maternal hypoglycemia was observed among patients delivering after 37 weeks managed with conventional insulin drip (4.29 vs 0.99 %, p =0.005). In ANCOVA analysis accounting for gestational age, association between mode of insulin dosing and neonatal glucose remained significant.

Conclusion:

Glucommander insulin management software shows similar time in target glucose range compared with conventional insulin drip dosing with lower rates of maternal hypoglycemia in term patients. Lower rates of neonatal hypoglycemia were noted with no difference in rates of neonatal intensive care admission due to low blood glucose.