Intrapartum maternal glycaemic control for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis

Abstract

Background: Neonatal hypoglycaemia is the most common metabolic disorder in infants, and may be influenced by maternal glycaemic control. This systematic review evaluated the effect of intrapartum maternal glycaemic control on neonatal hypoglycaemia.

Methods: We included randomised controlled trials (RCTs), quasi-RCTs, non-randomised studies of interventions, and cohort or case-control studies that examined interventions affecting intrapartum maternal glycaemic control compared to no or less stringent control. We searched four databases and three trial registries to November 2023. Quality assessments used Cochrane Risk of Bias 1 or the Effective Public Health Practice Project Quality Assessment Tool. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Meta-analysis was performed using random-effects models analysed separately for women with or without diabetes. The review was registered prospectively on PROSPERO (CRD42022364876).

Results: We included 46 studies of women with diabetes and five studies of women without diabetes: one RCT, 32 cohort and 18 case-control studies (11,273 participants). For women with diabetes, the RCT showed little to no difference in the incidence of neonatal hypoglycaemia between tight versus less tight intrapartum glycaemic control groups (76 infants, RR 1.00 (0.45, 2.24), p = 1.00, low certainty evidence). However, 11 cohort studies showed tight intrapartum glycaemic control may reduce neonatal hypoglycaemia (6,152 infants, OR 0.44 (0.31, 0.63), p < 0.00001, I² = 58%, very low certainty evidence). For women without diabetes, there was insufficient evidence to determine the effect of tight intrapartum glycaemic control on neonatal hypoglycaemia.

Conclusions: Very uncertain evidence suggests that tight intrapartum glycaemic control may reduce neonatal hypoglycaemia in infants of women with diabetes. High-quality RCTs are required.

Keywords: Glycaemic control; Hypoglycaemia; Infant; Intrapartum; Labour; Neonatology; Newborn.

Fig. 1

PRISMA flow diagram of included studies

Fig. 2

Risk of bias assessment, summary and quality assessment. (A) Cochrane Risk of Bias tool 1 risk of bias graph: each domain is represented as a percentage for the single RCT. (B) Cochrane Risk of Bias tool 1 risk of bias summary graph for the single RCT included. (C) Effective Public Health Practice Project quality assessment graph for the 50 observational studies

Fig. 3

Effect of tight compared to less tight or no intrapartum glycaemic control in women with diabetes on neonatal hypoglycaemia. (A) Results from one randomised controlled trial (B) Results from 11 cohort studies (C) Funnel plot for 11 cohort studies (D) Results from the forest plot for cohort studies reporting adjusted values (E) Results from 13 case control studies (F) Funnel plot for 13 case-control studies

Fig. 4

Tighter versus less tight intrapartum glycaemic control in women with gestational, type 1 and type 2 diabetes