Daphne N Voormolen1, Leon de Wit2, Bas B van Rijn1, J Hans DeVries3, Martijn P Heringa1, Arie Franx1, Floris Groenendaal4, Marije Lamain-de Ruiter1. 1. Department of Obstetrics and Gynaecology, Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 2. Department of Obstetrics and Gynaecology, Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands l.dewit-3@umcutrecht.nl. 3. Department of Endocrinology, Academic Medical Centre, Amsterdam, the Netherlands. 4. Department of Neonatology, Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Abstract
OBJECTIVE: To assess the risk of neonatal hypoglycemia following diet-controlled and insulin-treated gestational diabetes mellitus (GDM) and how it relates to birth weight. RESEARCH DESIGN AND METHODS: Prospective cohort study included term neonates born after GDM from January 2013 through December 2015 at the University Medical Center Utrecht (Utrecht, the Netherlands). Routine screening of neonatal blood glucose levels was performed at 1, 3, 6, 12, and 24 h after birth. Main outcome measures were neonatal hypoglycemia defined as blood glucose ≤36 mg/dL (severe) and ≤47 mg/dL (mild). RESULTS: A total of 506 neonates were included, born after pregnancies complicated by GDM treated either with insulin (22.5%) or without insulin (77.5%). The incidence of mild and severe hypoglycemia was similar in the insulin-treated and diet-controlled groups (33 vs. 35%, P = 0.66; and 20 vs. 21%, P = 0.79). A birth weight >90th centile was seen in 17.2% of all infants. Although children with a birth weight >90th centile had the highest risk for hypoglycemia, the vast majority of hypoglycemia (78.6%) was detected in those with a birth weight <90th centile. Over 95% of all hypoglycemia occurred within 12 h after birth. CONCLUSIONS: Routine screening for neonatal hypoglycemia following pregnancies complicated by GDM reveals high incidence of both mild and severe hypoglycemia for both diet-controlled and insulin-treated GDM and across the full range of birth weight centiles. We propose routine blood glucose screening for neonatal hypoglycemia within the first 12 h of life in all neonates after GDM, irrespective of maternal insulin use or birth weight.
OBJECTIVE: To assess the risk of neonatal hypoglycemia following diet-controlled and insulin-treated gestational diabetes mellitus (GDM) and how it relates to birth weight. RESEARCH DESIGN AND METHODS: Prospective cohort study included term neonates born after GDM from January 2013 through December 2015 at the University Medical Center Utrecht (Utrecht, the Netherlands). Routine screening of neonatal blood glucose levels was performed at 1, 3, 6, 12, and 24 h after birth. Main outcome measures were neonatal hypoglycemia defined as blood glucose ≤36 mg/dL (severe) and ≤47 mg/dL (mild). RESULTS: A total of 506 neonates were included, born after pregnancies complicated by GDM treated either with insulin (22.5%) or without insulin (77.5%). The incidence of mild and severe hypoglycemia was similar in the insulin-treated and diet-controlled groups (33 vs. 35%, P = 0.66; and 20 vs. 21%, P = 0.79). A birth weight >90th centile was seen in 17.2% of all infants. Although children with a birth weight >90th centile had the highest risk for hypoglycemia, the vast majority of hypoglycemia (78.6%) was detected in those with a birth weight <90th centile. Over 95% of all hypoglycemia occurred within 12 h after birth. CONCLUSIONS: Routine screening for neonatal hypoglycemia following pregnancies complicated by GDM reveals high incidence of both mild and severe hypoglycemia for both diet-controlled and insulin-treated GDM and across the full range of birth weight centiles. We propose routine blood glucose screening for neonatal hypoglycemia within the first 12 h of life in all neonates after GDM, irrespective of maternal insulin use or birth weight.
Authors: Leon de Wit; Doortje Rademaker; Daphne N Voormolen; Bettina M C Akerboom; Rosalie M Kiewiet-Kemper; Maarten R Soeters; Marion A L Verwij-Didden; Fahima Assouiki; Daniela H Schippers; Mechteld A R Vermeulen; Simone M I Kuppens; Mirjam M Oosterwerff; Joost J Zwart; Mattheus J M Diekman; Tatjana E Vogelvang; P Rob J Gallas; Sander Galjaard; Willy Visser; Nicole Horree; Tamira K Klooker; Rosemarie Laan; Rik Heijligenberg; Anjoke J M Huisjes; Thomas van Bemmel; Claudia A van Meir; Annewieke W van den Beld; Wietske Hermes; Solrun Vidarsdottir; Anneke G Veldhuis-Vlug; Remke C Dullemond; Henrique J Jansen; Marieke Sueters; Eelco J P de Koning; Judith O E H van Laar; Pleun Wouters-van Poppel; Marina E Sanson-van Praag; Eline S van den Akker; Catherine B Brouwer; Brenda B Hermsen; Bert Jan Potter van Loon; Olivier W H van der Heijden; Bastiaan E de Galan; Marsha van Leeuwen; Johanna A M Wijbenga; Karin de Boer; Arianne C van Bon; Flip W van der Made; Silvia A Eskes; Mirjam Zandstra; William H van Houtum; Babette A M Braams-Lisman; Catharina R G M Daemen-Gubbels; Maurice G A J Wouters; Richard G IJzerman; Nico A Mensing van Charante; Rolf Zwertbroek; Judith E Bosmans; Inge M Evers; Ben Willem Mol; Harold W de Valk; Floris Groenendaal; Christiana A Naaktgeboren; Rebecca C Painter; J Hans deVries; Arie Franx; Bas B van Rijn Journal: BMJ Open Date: 2019-08-18 Impact factor: 2.692
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