Category: Diabetes
Poster Session I
Women with gestational diabetes mellitus (GDM) and pre-labor rupture of membranes (PROM) at term present a challenge; data regarding management of this scenario is lacking in the literature. We tested the hypothesis that a prolonged PROM-delivery time in these women would result in a more frequent neonatal hypoglycemia.
Study Design:
A retrospective study between January 2010 and January 2020. Eligible were non-laboring women with singleton pregnancies ≥ 37 weeks of gestation, vertex presentation, diet, or insulin-controlled GDM, who presented with spontaneous clear PROM. Each woman was allocated into one of two groups based on the PROM-delivery time, < 18 hours (group 1) and ≥ 18 hours (group 2). The primary outcome was the incidence of neonatal hypoglycemia, defined as glucose ˂ 40 mg/dL (2.2 mmol/L) within 24 hours of birth.
Results:
Throughout the study period, 9,443 women were admitted with confirmed PROM at term. We analyzed 631 cases of gestational diabetes (6.7 percent), 371 with PROM-delivery < 18 hours, and 260 with PROM-delivery ≥ 18 hours.
Pregnant women in group 1 were more likely to be multiparous (59.3% vs. 40%, p< 0.001), and fewer required oxytocin during labor (35.6% vs. 77.3%, p< 0.001) or used epidural analgesia (72.2% vs. 88.1%, p< 0.001). The mean PROM-delivery time was significantly shorter in group 1 compared with group 2 (9.62 ± 4.86 hours vs. 29.61 ± 12.71 hours, p< 0.001). The incidence of the primary outcome, neonatal hypoglycemia, did not differ between the two groups, reaching 7.3% (Figure 1). Women in group 1 were at a reduced risk of cesarean delivery (12.4% vs. 20%, P< 0.01) and maternal chorioamnionitis morbidity (1.3% vs. 6.5%, P< 0.001).
Conclusion:
The present study implies that in a sub-group of women with GDM, a PROM-delivery time ≥ 18 hours is not associated with a higher rate of neonatal hypoglycemia, but a higher rate of adverse secondary outcomes. Therefore, we suggest consideration for early delivery when managing women with GDM and PROM.
Chen Ben David, MD
Rambam Health Care Campus
Haifa, Israel, Israel
Gal Bachar, MD (she/her/hers)
Rambam Healthcare Campus
Haifa, Israel
Nizar Khatib, MD
Rambam Healthcare Campus
Acre, Hefa, Israel
Dana Vitner, MD
Rambam Health Care Campus
Yuval Ginsberg, MD (he/him/his)
Deputy Ob/Gyn department
Rambam Medical Health Campus
Haifa, Israel
Ron Beloosesky, MD
Rambam Medical Health Campus
Haifa, Israel, Israel
Zeev Weiner, MD
Rambam Health Care Campus
Haifa, Israel, Israel
Yaniv Zipori, MD
Rambam Healthcare Campus
Binyamina, HaZafon, Israel