Intrapartum Continuous Subcutaneous Insulin Infusion Versus Intravenous Insulin Infusion Among Pregnant Individuals With type 1 Diabetes Mellitus: A Randomized Controlled Trial

( Am J Obstet Gynecol . 2023;229(6):680.e1–680.e8. doi: 10.1016/j.ajog.2023.07.003) Type 1 diabetes mellitus (T1DM) requires life-long insulin management and is a component of pregestational diabetes, affecting 1% to 2% of all pregnancies. Maternal exposure to placental hormones heightens insulin resistance and the potential for poor glycemic control. Hypoglycemia, diabetes-related complications, diabetic ketoacidosis, congenital anomalies, stillbirth, macrosomia, cesarean delivery, polyhydramnios, and hypertensive disorders or pregnancy are known complications of T1DM, especially in the setting of poor glycemic management. Neonatal exposure to high maternal blood sugar during pregnancy can lead to severe complications like neonatal hypoglycemia, respiratory distress syndrome, polycythemia, and jaundice and maternal glucose control in labor is important for neonatal hypoglycemia reduction. Optimal intrapartum glycemic control methods vary among providers, ranging from continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion, with limited data on neonatal outcomes. This study sought to understand the effect of intrapartum CSII in comparison to IV insulin infusion on first neonatal blood glucose level in pregnant patients with T1DM utilizing CSII at baseline.