Monitoring during the later stage of pregnancy and during labor: Glycemic considerations

This chapter explores glycemic physiology and pathophysiology during the later stages of normal and diabetic pregnancy are described followed by a description of current glucose monitoring and insulin treatment management options as well as some organizational issues. Monitoring and treatment are aimed at maintaining maternal plasma glucose levels within a safe range to prevent fetal growth promotion, to prevent maternal hypo- and hyperglycemia, and to prevent neonatal hypoglycemia. Classic monitoring means glucose measurements in capillary blood obtained by finger stick. Hopefully, the continuous glucose monitoring in women with type 1 diabetes in pregnancy trial and the neonatal spinoff trial may shed further light on the best peripartum and neonatal policy. A well-organized structure of care and counseling is of prime importance when caring for these women. The incidence of neonatal hypoglycemia depends not only on the definition of hypoglycemia but also on the specific protocol for neonatal care directly after birth.