Does tight intrapartum glycaemic control reduce the risk of neonatal hypoglycaemia?

For intrapartum glycaemic control, follow recommendations of the national guideline “Testing for, diagnosing and managing gestational diabetes (diabetes of pregnancy) Te whakamātau, te tautohu me te whakahaere i te mate huka hapūtanga”. [Conditional recommendation for either option]

Very low certainty of evidence showed potential benefit in reducing neonatal hypoglycaemia and admission to NICU, but also potential harm including increased caesarean section and reduction in exclusive breastfeeding.

Tighter glycaemic control during labour may be more relevant for women with type I and type II diabetes than women with GDM. Clinical decision-making should determine the appropriate level of intrapartum control and monitoring on an individualised basis.

Nil.

Studies are needed on:

• The effects of tight glycaemic control during labour for women with Type I and Type II diabetes, and GDM, including short-term and long-term maternal and neonatal/childhood outcomes. Given the potential iatrogenic harms associated with this treatment approach, separate recommendations may be necessary for each group.
   

People living in rural areas face challenges in accessing specialised care. Although women with diabetes often give birth at specialist centres, some may not have received a timely diagnosis during pregnancy, potentially leading to inequitable access to appropriate care and interventions. The responsibility lies with the system to facilitate equitable access, removing barriers rather than placing the burden on whānau.