Prelabor rupture of membranes in women with gestational diabetes and the risk of neonatal hypoglycemia

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. 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. 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). 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.View Large Image Figure ViewerDownload Hi-res image Download (PPT)