Glycaemic control in labour with diabetes (GILD)

Diabetes in pregnancy affects at least 5% of pregnant women. For most women this is gestational diabetes (GDM) (87.5%), but 12.5% women have pre-existing diabetes.

There is evidence that ‘tight’ glycaemic control in pregnancy reduces the risk of adverse outcomes for the mother and the baby. Traditionally ‘tight’ glucose control (target 4-7 mmol/L) is recommended in labour. Treatment with intravenous insulin may be needed during labour to maintain ‘tight’ control, however, this increases the risk of maternal hypoglycaemia in labour, which carries a risk to the mother.

Hourly intrapartum testing is also intrusive for women and time consuming for health care practitioners. Conversely, accepting more permissive glucose levels in the mother may be detrimental to the baby. Maternal hyperglycaemia results in increased fetal insulin production because of excess placental transfer of glucose and can lead to neonatal hypoglycaemia.

This study will assess whether it is feasible to run a trial to assess the clinical and cost-effectiveness of permissive versus intensive intrapartum glycaemic control in women with pregnancies complicated by diabetes.