Glycemic Control and Perinatal Outcome in Critically ill Pregnant Patients with Diabetes

Abstract

Aims: Identify the percentage of achievement of the goal of glycemic control, insulin therapy, frequency of hypoglycemia and perinatal outcomes in critically ill pregnant diabetic patients. Study Design:  Observational, longitudinal, retrospective, descriptive and analytical study. Place and Duration of Study: Intensive Care Unit (ICU) belonging to the High Specialty Medical Unit Gynecology and Obstetrics Hospital No. 3 of the National Medical Center “La Raza” from the Mexican Institute of Social Security, Mexico City, between January 1, 2022 and December 31, 2024. Methodology: A cohort of 39 critically ill pregnant patients with diabetes mellitus (type 1 n=16, type 2 n=9, gestational n=14) was studied. Their files were consulted to obtain the information necessary for the investigation. Blood glucose levels at admission and discharge from the ICU were compared to determine the percentage of glycemic control (goal <180 mg/dL), insulin therapy used, frequency of hypoglycemia (<40 mg/dL), and perinatal outcomes. The data were analyzed with descriptive and inferential statistics (Mann Whitney U test and Chi square) using the SPSS statistical program version 22. The value of P <0.05 was shown to be significant. Results: Blood glucose was significantly reduced (admission 234.36±105.47 vs discharge 121±37.83 mg/dL, P=.007). Goal of glycemic control was achieved in 92.30% in 1.85±1.69 days using 10 different rapid-acting insulin regimens. The intravenous bolus scheme was the most successful. Hypoglycemia occurred in 12.82%, in all cases with continuous intravenous insulin infusion. The ICU stay was 3.05±2.15 days with mortality 0%. The pregnancy was interrupted in 82.05%. The indication for termination of pregnancy was directly based on the reason for admission of the patients to the ICU and not necessarily with hyperglycemia. Perinatal complications: prematurity (<37 weeks) 71.88%, neonatal hypoglycemia 28.12%, congenital malformations 18.76%, macrosomia 12.5%, hypocalcemia 9.38%, sepsis 3.12% and fetal mortality 18.75%. Conclusion: The percentage of glycemic control was high. Insulin therapy was very varied. The frequency of maternal hypoglycemia was elevated with continuous intravenous insulin infusion. Perinatal outcomes were adverse.