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Q&A

Diabetes

Poster Session 3

(899) Glucose Monitoring in Labor: Does the Frequency Matter?

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Thomas Owens, MD

Dr Thomas Owens
Mount Sinai West
New York, NY, United States

Coauthor(s)

Olivia Grubman, MD,MPH

Mount Sinai West
New York, NY, United States
XY

Xiteng Yan, MD

OBGYN resident
Mount Sinai South Nassau
Oceanside, NY, United States
ER

Eric Reynolds, MA

Icahn School of Medicine
New York, NY, United States
Mia A. Heiligenstein, MD

Resident
Stony Brook University Hospital
Amityville, NY, United States
Tirtza Spiegel Strauss, MD

Fellow
Maimonides Medical Center
New York, NY, United States
GA

Graham Ashmead, MD

Roosevelt Hospital
New York, NY, United States
DC

David Cole, MD

Mt. Sinai West
New York, NY, United States
ZA

Zainab Al-Ibraheemi, MD

Mount Sinai West
N Caldwell, NJ, United States
LB

Lois Brustman, MD

St. Luke's Roosevelt Hospital Center
New York, NY, United States

Objective: In patients with gestational diabetes (GDM), there are limited protocols of intrapartum glucose monitoring with minimal guidance from obstetrical societies. Neonatal hypoglycemia is a complication of the maternal glucose levels intrapartum, with an incidence as high as 40%. The hypothesis of this study is that there is no difference in the rates of neonatal hypoglycemia with differing protocols in frequency of glucose monitoring during labor.

Study Design: A retrospective cohort study of patients with GDM that were diet controlled (A1) and medication controlled (A2) undergoing labor/induction from 2020-2023 were studied. Two groups were identified: Group 1(infrequent) had blood glucose(BG) levels every 4 hours in latent labor, and 2 hours in active labor, and Group 2(frequent) had BG levels every 2 hours in latent labor, and 1 hour in active labor. Primary outcome was to assess rates of neonatal hypoglycemia between these 2 groups at delivery. Demographics as seen in table 1 were studied. Wald Confidence Limits of the Odds Ratio estimates were used to test for non-inferiority. Variables were compared using Chi-square and Mann-Whitney U test. p< 0.05 was considered significant.

Results: Of 508 subjects, 285(56%) had infrequent monitoring, and 223(44%) had frequent monitoring. Patients with infrequent testing were more likely to have A1GDM(p< .01), have better diabetic control(p< .01), lower BMI(p< .01), less likely to have LGA(p< .01), and less likely to be induced(p< .01). Neonatal hypoglycemia did not differ between the two groups(p=0.11), as seen in table 1. Adjusting for control, compliance, type of GDM, age, BMI, and need for insulin drip showed infrequent monitoring was non-inferior to frequent monitoring in relation to neonatal hypoglycemia(aOR 0.56[90% 0-1.35]).

Conclusion: Our study suggests there is no difference in rates of neonatal hypoglycemia regardless of these glucose monitoring protocols intrapartum. This study can lay the foundation for future studies to provide intrapartum glucose monitoring protocols, which would lessen invasive testing and improve patient satisfaction.