The Neonatal Hypoglycemia of Term Infants: A Prospective Comparative Study between Well Diet-controlled Gestational Diabetes (GDM A1) and Normal Pregnancy

Abstract

The objective of these prospective comparative study was to compare neonatal hypoglycemia
and morbidities between term infants born to well diet-controlled gestational diabetes (GDM A1)
women and those to normal pregnancy. A total of 41 infants born to GDM A1 women (diabetic
group) and 40 infants born to nondiabetic women (control group) at ≥ 37 weeks of gestation at
Department of Pediatrics, Somdejprasangkharaj 17th Hospital, Suphan Buri, were randomized into
each group. Subjects were monitored for the development of hypoglycemia and other morbidities.
Blood glucose screening was performed in diabetic group every 30-60 minutes three times, starting
soon after birth and then at 3-hour intervals before each feeding for 24 hours. Breast feedings were
started shortly after birth and provided every 3 hours for at least 24 hours. All women with GDM A1
and normal pregnancy had an HbA1c measured before delivery. It was found that there were no
differences in demographic characteristics of maternal and infants between the two groups. Mean
birth weight of both groups were 3104.6 gm vs 3207.8 gm, macrosomia were 3 infants (7.3%) vs 2
infants (5.0%), birth trauma were 3 infants (7.3%) vs 2 infants (5.0%), hyperbilirubinemia were 5
infants (12.2%) vs 6 infants (15.0%), hematocrit were 59.3 percent vs 52.1 percent. Blood glucose
readings before feedings were low (<40 mg/dl) in 12 infants (29.3%) vs 9 infants (22.5%), but those
confirmed for hypoglycemia were only 5 infants (12.2%) vs 4 infants (10.0%). However, no significant
differences in the odds ratio (1.25; 95% CI 0.31, 5.03; p 0.753) of neonatal hypoglycemia
according to diabetic in pregnancy were observed. No infants in either group had symptoms of
hypoglycemia and required intravenous dextrose infusion for treatment. Hypoglycemic episodes in
the infants from the diabetic group could be managed with oral feedings alone. Based on logistic
regression analysis, birth weight, gestational age, sex, Apgar scores, and maternal HbA1c levels
could not predict low glucose readings on initial screening in infants from the diabetic group. However,
none of all infants had serious morbidities, hypoxic-ischemic encephalopathy, polycythemia,
hypocalcemia, or hypomagnesemia. In conclusion, the infants born to the well diet-controlled GDM
A1 at ≥ 37 weeks of gestation, the incidence of hypoglycemia and morbidities of infants in the
diabetic group was similar to that of the infants born to the nondiabetic women. Low blood glucose
levels during the first few hours of life can be prevented or treated with early and frequent oral
feedings.
Key words: neonatal hypoglycemia, neonatal morbidities, GDM-A1, gestational diabetes mellitus class A1, diet-controlled, term pregnancy