Endocrine Abstracts (2018) 59 OC4.4 | DOI: 10.1530/endoabs.59.OC4.4

An intravenous insulin protocol designed for pregnancy reduces neonatal hypoglycaemia after betamethasone administration in women with gestational diabetes

Christopher Rowe1,2, Elise Putt1, Olivia Brentnall1, Alison Gebuehr1, Jackie Allabyrne3, Andrew Woods2,3 & Katie Wynne1,2

1Department of Endocrinology and Diabetes, John Hunter Hospital, Newcastle, Australia; 2School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; 3Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, Australia.

Introduction: Neonatal hypoglycaemia (NH) is common in infants born soon after betamethasone administration, and may be reduced by at-target peri-partum glycaemic control. A Pregnancy-specific Intravenous Insulin-Glucose Infusion (PIIGI) protocol was introduced at a tertiary hospital in June 2017, replacing a generic Adult IntraVenous Insulin protocol (AIVI) not designed for pregnancy, without change in indication for IV insulin (initiated with any BGL>6.7 mmol/L following betamethasone, and continued for 24 hours after the final dose of betamethasone). Capillary glucose levels are measured every 30–60 minutes whilst on infusion.

Patients and methods: A prospective audit June 2017-May 2018 captured all uses of PIIGI following betamethasone in women with gestational diabetes (n=65), and compared to a similar retrospective cohort treated with AIVI (n=86). Primary outcome was percentage of on-infusion time at target (BGL 3.8–7 mmol/L). Secondary outcomes were percentage time with critical hyperglycaemia (BGL>10 mmol/L) or hypoglycaemia (BGL<3.8 mmol/L), and incidence of NH (BGL<2.7 mmol/L in first 48 hours if betamethasone given within 2 days of birth). As this was a real-world analysis of practice, a waiver of consent was granted by the Human Research Ethics Committee.

Results: On-infusion time at target was 68% (95%CI 64–71%) for PIIGI compared to 55% (95%CI 50–60%) for AIVI (P=0.0002). Critical hyperglycaemia was lower with PIIGI compared to AIVI (2% vs 5%, P=0.006), with no change in rate of hypoglycaemia (0.1% vs 0.5%, P=0.09). NH occurred with 11/31 (35%) of births following PIIGI, compared to 29/48 (60%) births following AIVI (P=0.03). A multiple logistic regression model adjusting for potential confounders gave an odds ratio for NH with PIIGI of 0.30 (95%CI 0.11–0.82, P=0.02).

Conclusions: An infusion protocol designed for pregnancy effectively controlled maternal hyperglycaemia following betamethasone. This is the first protocol to show reduction in betamethasone-associated NH associated with optimum maternal glycaemic control.

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