| Title: |
Glycaemic control in labour with diabetes: GILD, a scoping study |
| Authors: |
Nia Wyn Jones; Eleanor J Mitchell; Kate F Walker; Susan Ayers; Lucy Bradshaw; Georgina Constantinou; Tasso Gazis; Shalini Ojha; Phoebe Pallotti; Stavros Petrou; Rachel Plachcinski; Michael Rimmer; Liz Schroeder; Jim G Thornton; Natalie Wakefield |
| Source: |
Health Technology Assessment, Vol 29, Iss 41 (2025) |
| Publisher Information: |
NIHR Journals Library |
| Publication Year: |
2025 |
| Collection: |
Directory of Open Access Journals: DOAJ Articles |
| Subject Terms: |
female; humans; pregnancy; labour; infant; newborn; blood glucose; diabetes; diabetes mellitus; gestational; type 2; type 1; insulin; glycaemic control; mixed methods study; cost–benefit analysis; glucose; mothers; blood glucose self-monitoring; hyperglycaemia; placenta; hypoglycaemia; insulin regular human; hyperinsulinism; health personnel; hospitals; united kingdom; Medical technology; R855-855.5 |
| Description: |
Background Diabetes in pregnancy is common, affecting 5–10% of pregnant women. Poor glycaemic control in labour is associated with neonatal hypoglycaemia and other adverse outcomes for mother and baby, but tight glucose control is burdensome, intrusive and may not always be necessary. The ideal intrapartum glucose target level is unknown, traditionally ‘tight’ control (target 4–7 mmol/l) has been recommended; however, this increases the risk of maternal hypoglycaemia. Objective To determine the feasibility of a randomised clinical trial to compare clinical and cost-effectiveness of permissive versus intensive intrapartum glycaemic control in labour in pregnancies complicated by diabetes. Design A mixed-methods study including audit of clinical guidelines from United Kingdom maternity units, online surveys of women with diabetes and healthcare professionals, service evaluation of intrapartum glycaemic care, Delphi survey and consensus meeting. Data from these work packages led to the design of a clinical trial, and qualitative interviews were held to understand acceptability of the trial. Setting National Health Service maternity services and online input from service users. Participants Healthcare professionals and women with type 1 or type 2 diabetes mellitus or gestational diabetes (currently pregnant or having birthed after active labour in past 3 years). Results There is significant variation in the recommended frequency of testing for gestational diabetes in labour, technologies used to test glucose levels in labour and administer insulin in type 1 diabetes mellitus, and in how neonatal hypoglycaemia is defined. Of surveyed women, 66% would be willing to participate in a future trial, with 23% unsure without further information. The service evaluation showed that once glucose testing had commenced, it was repeated after 1 hour in 18%, 2 hours in 38% and 4 hours in 45% of women. Neonatal hypoglycaemia was considered the most important neonatal outcome for a future trial, with maternal satisfaction the most ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
https://doi.org/10.3310/KHGD2761; https://doaj.org/toc/2046-4924; https://doaj.org/article/e56c2553fd7a4082a07ac115e01e758e |
| DOI: |
10.3310/KHGD2761 |
| Availability: |
https://doi.org/10.3310/KHGD2761; https://doaj.org/article/e56c2553fd7a4082a07ac115e01e758e |
| Accession Number: |
edsbas.604FACFB |
| Database: |
BASE |