Abstract
Current management of diabetes in pregnancy includes prompt normalization of glucose
prior to delivery in women with poorly controlled diabetes. While the benefits of
glucose control throughout pregnancy are well-documented, the benefits of rapid glucose
normalization prior to delivery are borderline. There is a lack of information on
the fetal effects of this practice. There is a concern that a rapid decrease in maternal
glucose level could cause hypoglycemia in the fetus, developing in the same manner
as in a newborn infant of a mother with diabetes. This case highlights a 37 week infant
of a mother with poorly controlled diabetes, whose mother's glucose was normalized
with intravenous insulin 24 hours before delivery. The infant's arterial cord blood
glucose was 2.1 mmol/L, indicative of hypoglycemia, and it required neonatal intensive
care unit admission. Current guidelines emphasize tight peripartum glycemic control
but overlook potential fetal hypoglycemia before birth. This case suggests fetal hypoglycemia
may precede neonatal hypoglycemia, with similar risks but limited diagnostic opportunities.
Further research is needed to evaluate fetal outcomes of stringent glycemic control
and to establish early cord blood glucose monitoring to improve the identification
and management of hypoglycemia in this vulnerable population.
Keywords
cord blood glucose - fetal blood glucose - hypoglycemia - infant of diabetic mother
- infant - newborn - peripartum period
