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

Clinical highlights

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.

Volume 59

Society for Endocrinology BES 2018

Glasgow, UK
19 Nov 2018 - 21 Nov 2018

Society for Endocrinology 

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