Glycemic control during labor and delivery: A survey of academic centers in the United States

Purpose SigniWcant controversy surrounds the management of blood glucose levels during labor and delivery. The American College of Obstetrics and Gynecology has recommended "tight" blood glucose control (<110 mg/dL). However, there is concern that tight control can increase the incidence of maternal hypoglycemia. Thus, there remains a lack of consensus regarding glycemic control during labor and delivery. To assess the current intrapartum glycemic management, we surveyed obstetrical residency programs in the United States. Methods Questionnaires were distributed via email and if there was no response within 3 weeks, they were mailed to obstetrics/gynecology residency program directors. Results Of the 117 questionnaires distributed, 49 responses (41.9%) were received, but one was excluded, as it was incomplete. Although 85% of responders reported having a written protocol in place regarding intrapartum BG management, there was signiWcant variation in target blood glucose levels, maintenance of those levels, monitoring of glucose levels, and Xuid management during labor and delivery. Conclusion The key Wnding of our survey is that there is signiWcant variation in blood glucose management during labor and delivery. This survey identiWes areas for improvement as well as areas for future research. Given the sparse obstetrical literature, properly conducted trials are necessary to assess all aspects of optimal intrapartum glucose management.