Normal saline for the intrapartum management of the insulin-dependent diabetic patient

Objectives: To evaluate the safety and efficacy of saline alone for the intrapartum management of insulin-requiring diabetic patients and their infants. Methods: This was a retrospective evaluation of 77 insulin-requiring diabetic patients, over a 12-year period ending 1 January 1994. All patients began labor, either induced or spontaneous, with an intravenous infusion of 0.9% saline, reserving insulin, and/or dextrose for patients with plasma glucose measurements consistently outside the threshold values of 3.5 mmol/l (63 mg/dl) and 6.5 mmol/l (117 mg/dl). Neonates were assessed for hypoglycemia and other complications. Results: Forty-four patients (57%) had diabetes prior to their pregnancy, with a mean length of diabetes of 9.9 years. Neither insulin nor dextrose was required in labor by 70.1% of mothers. Insulin-requiring gestational diabetic patients were more likely to remain euglycemic in labor than those whose diabetes predated their pregnancy (87.9% vs. 56.8%, p = 0.005). Only one mother experienced transient symptoms of hypoglycemia. The incidence of neonatal hypoglycemia was 11.7%. Conclusions: Most insulin-requiring diabetic patients will remain euglycemic in labor without insulin or dextrose. There were no major maternal consequences with this approach and the incidence of neonatal hypoglycemia was less than that usually quoted. The simplicity of this approach promotes safety and, in the majority of cases, decreases the cost and potential adverse effects of insulin and dextrose.

Duke Scholars

Author Elizabeth Gresham Livingston Obstetrics and Gynecology, Maternal Fetal Medicine