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. 2021 Dec;41(12):2754-2760.
doi: 10.1038/s41372-021-01292-3. Epub 2022 Jan 4.

Reexamining intrapartum glucose control in patients with diabetes and risk of neonatal hypoglycemia

Tooba Z Anwer  1   2 , Ricardo Aguayo  1 , Anna M Modest  1   2 , Ai-Ris Y Collier  3   4
Affiliations

Reexamining intrapartum glucose control in patients with diabetes and risk of neonatal hypoglycemia

Tooba Z Anwer et al. J Perinatol. 2021 Dec.

Abstract

Objective: Compare the incidence of hypoglycemia in neonates born to patients with diabetes, based on last maternal glucose before delivery.

Study design: Cohort of singleton births from individuals with pregestational and gestational diabetes (GDM) from 2017 to 2019.

Results: We included 853 deliveries. Maternal hyperglycemia before delivery was associated with 1.8-fold greater risk of neonatal hypoglycemia (glucose < 45 mg/dL) in patients with GDM on medication (adjusted risk ratio (aRR): 1.8; 95% CI: 1.1-2.7), compared with euglycemia. This association was not seen in diet-controlled GDM (0.5; 0.23-1.1), nor in Type 1 (1.1; 0.88-1.4), or Type 2 pregestational diabetes (1.1; 0.61-1.9). Further, pregestational diabetes, compared to GDM, regardless of intrapartum maternal glucose control, was associated with neonatal hypoglycemia and NICU admission.

Conclusion: Maternal hyperglycemia before delivery only carried a higher risk of neonatal hypoglycemia in those with GDM on medications. Other interventions to reduce neonatal hypoglycemia are needed.

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Conflict of interest statement

Conflicts of Interest: The authors declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.. Participant Allocation
GDM= gestational diabetes, T1DM= Type 1 diabetes mellitus; T2DM= Type 2 diabetes mellitus. Maternal euglycemia was defined as capillary glucose ≤110 mg/dL and hyperglycemia was defined as glucose >110 mg/dL.
Figure 2.
Figure 2.. Risk of neonatal outcomes among women with pre-delivery hyperglycemia compared with euglycemia
Risk of neonatal hypoglycemia (<45 mg/dL) within 1 hour and within 2–24 hours from birth, and neonatal intensive care unit (NICU) admission for infants in the setting of maternal hyperglycemia >110 mg/dL compared to euglycemia are displayed as both crude risk ratio (black square) with 95% confidence intervals (bars) and adjusted risk ratio (blue circles) with 95% confidence intervals (bars) adjusted for maternal age, race/ethnicity, insurance status, BMI, and IV insulin use.
See this image and copyright information in PMC

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