Gregory A Kline1, Alun Edwards. 1. Division of Endocrinology, University of Calgary, Calgary, Alta., Canada. Gregory.kline@calgaryhealthregion.ca
Abstract
OBJECTIVE: Assess efficacy of intrapartum intravenous (i.v.) insulin and effect of antepartum and intrapartum diabetic control on various measures of clinical neonatal hypoglycemia. DESIGN: Retrospective chart review. SETTING: Regional Diabetes in Pregnancy Clinic. RESULTS: Maternal hypoglycemia occurred intrapartum in 56% of subjects. Mean delivery blood glucose with intravenous insulin use was 6.7mmol/l. Capillary blood glucose <2.2mmol/l occurred in 69% of neonates and 44% received intravenous glucose. Maternal delivery glucose >6.5mmol/l correlated with occurrence of neonatal glucose <2.2mmol/l but not requirement for i.v. glucose or NICU admission. A third trimester HbA1c >6.5% had a stronger association with NICU admission and i.v. glucose requirement. CONCLUSIONS: Blood glucose at delivery >6.5mmol/l predicts neonatal hypoglycemia but does not correlate with severity. Chronic maternal hyperglycemia, reflected by pre-delivery HbA1c, predicts severe fetal hyperinsulinism and requirement for aggressive intervention. This stresses the importance of a target third trimester HbA1c of <6.5%.
OBJECTIVE: Assess efficacy of intrapartum intravenous (i.v.) insulin and effect of antepartum and intrapartum diabetic control on various measures of clinical neonatal hypoglycemia. DESIGN: Retrospective chart review. SETTING: Regional Diabetes in Pregnancy Clinic. RESULTS:Maternal hypoglycemia occurred intrapartum in 56% of subjects. Mean delivery blood glucose with intravenous insulin use was 6.7mmol/l. Capillary blood glucose <2.2mmol/l occurred in 69% of neonates and 44% received intravenous glucose. Maternal delivery glucose >6.5mmol/l correlated with occurrence of neonatal glucose <2.2mmol/l but not requirement for i.v. glucose or NICU admission. A third trimester HbA1c >6.5% had a stronger association with NICU admission and i.v. glucose requirement. CONCLUSIONS:Blood glucose at delivery >6.5mmol/l predicts neonatal hypoglycemia but does not correlate with severity. Chronic maternal hyperglycemia, reflected by pre-delivery HbA1c, predicts severe fetal hyperinsulinism and requirement for aggressive intervention. This stresses the importance of a target third trimester HbA1c of <6.5%.
Authors: Rebecca J Griffith; Jane E Harding; Christopher J D McKinlay; Trecia A Wouldes; Deborah L Harris; Jane M Alsweiler Journal: Early Hum Dev Date: 2019-02-01 Impact factor: 2.079