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The duration of intrapartum maternal hyperglycaemia predicts neonatal hypoglycaemia in women with pre‐existing diabetes
Aim There is a high incidence of neonatal hypoglycaemia in neonates born to mothers with pre‐existing diabetes. This often necessitates admission to the neonatal intensive care. Guidelines suggest maintaining intrapartum blood glucose levels (BGLs) of 4–7 mmol/l in women with diabetes to reduce the...
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Published in: | Diabetic medicine 2017-05, Vol.34 (5), p.725-731 |
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Main Authors: | , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | Aim
There is a high incidence of neonatal hypoglycaemia in neonates born to mothers with pre‐existing diabetes. This often necessitates admission to the neonatal intensive care. Guidelines suggest maintaining intrapartum blood glucose levels (BGLs) of 4–7 mmol/l in women with diabetes to reduce the risk of neonatal hypoglycaemia. This study assessed whether intrapartum BGLs in women with pre‐gestational Type 1 and 2 diabetes were predictive of neonatal hypoglycaemia.
Methods
A retrospective analysis of 261 births delivered at a tertiary hospital in Australia from 2009 to 2014.
Results
There were 122 cases of neonatal hypoglycaemia (glucose ≤ 2.6 mmol/l) in 261 births (47%). The mothers in the neonatal hypoglycaemia group spent less time with BGL in the range 4–7 mmol/l [55 ± 37% vs. 65 ± 35%, P = 0.02; odds ratio (OR) 0.992, P = 0.03] and more time with BGL in the 7–10 mmol/l range (31 ± 34% vs. 18 ± 27%, P = 0.003; OR 1.013, P = 0.003) compared with those without neonatal hypoglycaemia. Although statistically significant, receiver operating characteristic (ROC) curve analysis showed that time spent with maternal BGLs in the range 4–7 mmol/l [area under the curve (AUC) = 0.58] or 7–10 mmol (AUC = 0.60) was not strong enough to be a useful clinical predictor of neonatal hypoglycaemia. HbA1c in the second trimester of pregnancy (P = 0.02, OR 1.42) and percentage time spent in BGL range of 7–10 mmol/l (P = 0.001, OR 1.02) were both associated with a risk of neonatal hypoglycaemia in a logistic regression model. HbA1c in the third trimester (P = 0.07, OR 1.28) approached, but did not reach, significance.
Conclusions
These data support a BGL range of 4–7 mmol/l as an intrapartum target. Glycaemic control in the second trimester is associated with neonatal hypoglycaemia. Improvement in ante‐ and intrapartum glycaemic control may reduce neonatal hypoglycaemia in women with pre‐existing diabetes.
What's new?
This study investigated the effect of intrapartum glycaemic control on neonatal hypoglycaemia in babies of mothers with pre‐existing diabetes.
Maternal hyperglycaemia during labour was associated with increased risk of neonatal hypoglycaemia: neonates with hypoglycaemia were more likely to have mothers who spent less time with blood glucose levels (BGLs) within the target range of 4–7 mmol/l and more time with BGLs in 7–10 mmol/l range.
Intrapartum hyperglycaemia and HbA1c in the second trimester of pregnancy were predictive of neonatal hypoglycaemia when anal |
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ISSN: | 0742-3071 1464-5491 |
DOI: | 10.1111/dme.13337 |