Poster Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Adoption of a pregnancy-specific intravenous insulin protocol (Pregnancy-IVI) at a regional centre has equivalent safety and efficacy outcomes as a tertiary hospital (#128)

Christopher W Rowe 1 2 , Angeline K Sathiakumar 1 , Soundarya Ramesh 1 , Patrick Rosee 1 , Vivian Qiao 1 , Sienna McWhae-Brown 3 , Eliza Griffiths 1 3 , Katie Wynne 1 2
  1. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  2. Department of Endocrinology and Diabetes, John Hunter Hospital, Newcastle, NSW, Australia
  3. Department of Maternity and Gynaecology, Maitland Hospital, Maitland, NSW, Australia

Aims: Glycaemic instability may occur in women with diabetes in pregnancy following betamethasone, during intercurrent illness and labour. The Pregnancy Intravenous-Insulin Infusion (Pregnancy-IVI) algorithm safely maintains maternal glucose and may consequently reduce neonatal hypoglycaemia (tinyurl.com/pregnancy-ivi) (1, 2). This study aims to establish the efficacy and safety of Pregnancy-IVI when implemented outside a tertiary-care hospital.

Method: A retrospective cohort of all admitted pregnant women treated with the Pregnancy-IVI at a tertiary level 6 (n = 344) or regional level 4 (n = 67) hospital for glycaemic instability following betamethasone administration (n=202), during intercurrent illness (n=45) or labour (n=167) during 2020-2021.  Women with type 1 diabetes were excluded as guidelines required level 6 care. Primary outcomes were on-IVI maternal glycaemic time-in-range (4.0-7.8mmol/L), and hours of on-IVI maternal hypoglycaemia (<3.8mmol/L or <3.0mmol/L) per 100 woman-IVI-hours.   Outcomes were assessed using Mann-Whitney or 95% CI of risk difference, stratified by indication for Pregnancy-IVI.

Results: Participant demographics (age, gravida, parity, BMI, diabetes type, gestational age, Pregnancy-IVI duration) were comparable between hospitals.  Gestational diabetes was diagnosed in 76% and type 2 diabetes in 24%.  Pregnancy-IVI glycaemic time-in-range was similar at the tertiary and regional site after betamethasone (82%[IQR 75-90%] vs 77%[IQR 68-86%] p=0.06), illness (87%[IQR 77-94%] vs 87%[IQR 64-94%] p=0.66) and labour (90%[IQR 73-100%] vs 94%[IQR 80-100%] p=0.53). Any maternal hypoglycaemia (<3.8mmol/l) was uncommon, and similar rates occurred at the tertiary and regional hospitals: following betamethasone (0.46 vs 0.61h/100wh, p=0.41), illness (0.69 vs 1.37h/100wh, p=0.13), and labour (1.62 vs 0.63h/100wh, P=0.09). Moderate maternal hypoglycaemia (<3.0mmol/L) was rare, with similar rates at both sites: betamethasone (0.05 vs 0.0h/100wh, p=0.46), illness (0.13 vs 0.27h/100wh, p=0.46, and labour (0.11 vs 0.0h/100wh, p=0.63).

Conclusions: This study provides evidence of the efficacy and safety of the Pregnancy-IVI algorithm in pregnant women with diabetes admitted to a level 4 regional hospital.

  1. 1. Rowe CW, Putt E, Brentnall O, Allabyrne J, Gebuehr A, Woods A, Wynne K (2018) An intravenous insulin protocol designed for pregnancy reduces neonatal hypoglycaemia following betamethasone administration in women with gestational diabetes. Diabetic Medicine https://doi.org/10.1111/dme.13864
  2. 2. Rowe CW, Watkins B, Brown K, Delbridge M, Addley J, Woods A, Wynne K (2020). Efficacy and safety of the Pregnancy-IVI, an intravenous insulin protocol for pregnancy, following antenatal betamethasone in Type 1 and Type 2 diabetes. Diabetic Medicine. https://doi.org/10.1111/dme.14489