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A Prospective Controlled Study of Neonatal Morbidities in Infants Born at 36 Weeks or More Gestation to Women with Diet-controlled Gestational Diabetes (GDM-class Al)

Journal of Perinatology volume 23, pages 223–228 (2003)Cite this article

Abstract

OBJECTIVE: Infants of gestational diabetes mellitus (GDM)-A1 women are unlikely to experience the marked excursion in maternal glucose levels that may characterize insulin-requiring GDM (class-A2) or insulin-dependent diabetes (IDDM). However, infants born to GDM-A1 women are traditionally managed like infants born to GDM-A2 or IDDM women.

AIMS: To examine monitoring protocols for infants of GDM-A1 women, and to examine the efficacy of early and frequent feedings to prevent and to treat hypoglycemia.

METHODS: A total of 92 of 101 infants born to GDM-A1 women (diabetic group) and 68 of 83 infants born to nondiabetic women (control group) at ≥36 weeks of gestation were prospectively monitored for the development of hypoglycemia and other morbidities. Blood glucose screening was performed in the diabetic group every 30–60 minutes three times, starting soon after birth and then at 3-hour intervals for 24 hours. Liberal feedings were started shortly after birth and provided every 3 hours for at least 24 hours. All women with GDM-A1 had an HbA1c measured before delivery.

RESULTS: Both the diabetic and control groups had similar demographics, including LGA incidence. Blood glucose readings before feedings were low (<40 mg/dl) in 24 of 92 infants (26.1%) from the diabetic group and in 20 of 68 control infants (29%). After the start of oral feedings, all but four diabetic and three control infants had subsequent glucose readings ≥40 mg/dl. No infant had symptoms of hypoglycemia and none from the diabetic group had birth trauma, hypoxic–ischemic encephalopathy, polycythemia, hypocalcemia, or hypomagnesemia. Hypoglycemic episodes in the infants from the diabetic group could be managed with oral feedings alone. 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.

CONCLUSION: The incidence of hypoglycemia in infants born to GDM-A1 women at ≥36 weeks of gestation is similar to control infants born to nondiabetic women. Low blood glucose levels during the first few hours of life can be prevented or treated with early and frequent oral feeding.

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References

  1. Landon MB, Gabbe SG, Piana R, Mennuti MT, Main EK . Neonatal morbidity in pregnancy complicated by diabetes mellitus: predictive value of maternal glycemic profiles. Am J Obstet Gynecol 1987;156:1089–1095.

    Article  CAS  Google Scholar 

  2. Gregory R, Scott AR, Mohajer M, Tattersall RB . Diabetic pregnancy 1977–90: Have we reached a plateau? J R Coll Physicians Lond 1992;26:162–166.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Cordero L, Landon MB . Infant of diabetic mother. Clin Perinatol 1993;20:635–647.

    Article  CAS  Google Scholar 

  4. Nasrat HA, Salleh M, Ardawi M, Ghafouri H . Outcome of pregnancy in diabetic mothers. Int J Gynecol Obstet 1993;43:29–34.

    Article  CAS  Google Scholar 

  5. Gabbe SG, Mestman JH, Freeman RK, Anderson GV, Lowensohn RI . Management and outcome of class A diabetes mellitus. Am J Obstet Gynecol 1977;127:465–469.

    Article  CAS  Google Scholar 

  6. Summary and recommendations of the Second International Workshop. Conference on Gestational Diabetes Mellitus. Diabetes 1985;34:123–126.

  7. Cloherty JP . Maternal conditions that affect the fetus. Diabetes Mellitus. In: Cloherty JP, Stark AR, editors. Manual of Neonatal Care/Joint Program in Neonatology, Harvard Medical School. NY: Lippincott-Raven Publishers; 1998. p. 11–20.

    Google Scholar 

  8. Gabbe GS . Gestational diabetes mellitus. N Engl J Med 1990;315:1025–1026.

    Article  Google Scholar 

  9. ACOG Technical Bulletin. Diabetes and pregnancy. Number 200 — December 1994 (replaces No. 92, May 1986). Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1995;48:331–339.

  10. Battaglia FC, Lubchenco LO . A practical classification of newborn infants by weight and gestational age. J Pediatr 1967;71:159–163.

    Article  CAS  Google Scholar 

  11. Cordero L, Treuer SH, Landon MB, Gabbe SG . Management of infants of diabetic mother. Arch Pediatr Adolesc Med 1998;152:249–254.

    Article  CAS  Google Scholar 

  12. Engelgau MM, Herman WH, Smith PJ, German RR, Aubert RE . The epidemiology of diabetes and pregnancy in the U.S., 1988. Diabetes Care 1995;18:1029–1033.

    Article  CAS  Google Scholar 

  13. Srinivasan G, Pildes RS, Cattamanchi G, Voora S, Lilien LD . Plasma glucose values in normal neonates: A new look. J Pediatr 1986;109:114–117.

    Article  CAS  Google Scholar 

  14. Comblath M, Hawdon JM, Williams AF, et al. Controversies regarding definition of neonatal hypoglycemia: Suggested operational thresholds. Pediatrics 2000;105:1141–1145.

    Article  Google Scholar 

  15. Deorari AK, Kabra SK, Paul VK, et al. Perinatal outcome of infants born to diabetic mothers. Indian J Pediatr 1991;28:1271–1275.

    CAS  Google Scholar 

  16. Salle BL, Delvin E, Glorieux F, David L . Human neonatal hypocalcemia. Biol Neonate 1990;58:22–31.

    Article  Google Scholar 

  17. Rosenn B, Tsang RC . The effects of maternal diabetes on the fetus & neonate. Ann Clin Lab Sci 1991;21:153–170.

    CAS  PubMed  Google Scholar 

  18. Suevo DM . The infant of diabetic mother. Neonatal Network 1997;16:25–33.

    CAS  PubMed  Google Scholar 

  19. Neiger R . Fetal macrosomia in the diabetic patient. Clin Obstet Gynecol 1992;35:138–150.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We acknowledge the valuable contributions of Prof. A.R. Spitzer and Prof. Thomas Wiswell of SUNY at Stony Brook, New York in editing the manuscript and for assistance in sample size calculation.

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  1. Subrata Sarkar MD

    Present address: SUNY at Stony Brook, Stony Brook, NY, 11794

Authors and Affiliations

  1. Department of Pediatrics, Maimonides, Medical Center, Brooklyn, NY, USA

    Subrata Sarkar MD & Henry A Schaeffer MD

  2. Department of Pediatrics, Coney Island Hospital, Brooklyn, NY, USA

    Jerry Watman MD & Warren M Seigel MD

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Sarkar, S., Watman, J., Seigel, W. et al. A Prospective Controlled Study of Neonatal Morbidities in Infants Born at 36 Weeks or More Gestation to Women with Diet-controlled Gestational Diabetes (GDM-class Al). J Perinatol 23, 223–228 (2003). https://doi.org/10.1038/sj.jp.7210882

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