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Reexamining intrapartum glucose control in patients with diabetes and risk of neonatal hypoglycemia

Journal of Perinatology volume 41, pages 2754–2760 (2021)Cite this article

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Abstract

Objective

Compare the incidence of hypoglycemia in neonates born to patients with diabetes, based on last maternal glucose before delivery.

Study design

Cohort of singleton births from individuals with pregestational and gestational diabetes (GDM) from 2017 to 2019.

Results

We included 853 deliveries. Maternal hyperglycemia before delivery was associated with 1.8-fold greater risk of neonatal hypoglycemia (glucose < 45 mg/dL) in patients with GDM on medication (adjusted risk ratio (aRR): 1.8; 95% CI: 1.1–2.7), compared with euglycemia. This association was not seen in diet-controlled GDM (0.5; 0.23–1.1), nor in Type 1 (1.1; 0.88–1.4), or Type 2 pregestational diabetes (1.1; 0.61–1.9). Further, pregestational diabetes, compared to GDM, regardless of intrapartum maternal glucose control, was associated with neonatal hypoglycemia and NICU admission.

Conclusion

Maternal hyperglycemia before delivery only carried a higher risk of neonatal hypoglycemia in those with GDM on medications. Other interventions to reduce neonatal hypoglycemia are needed.

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Fig. 1: Participant allocation.
Fig. 2: Risk of neonatal outcomes among women with pre-delivery hyperglycemia compared with euglycemia.

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Acknowledgements

AYC received salary support from the grant K12HD000849, awarded to the Reproductive Scientist Development Program by the Eunice Kennedy Shriver National Institute of Child Health & Human Development and Burroughs Wellcome Fund. AMM received salary support from the Charles Koch Foundation. The Charles Koch Foundation was not involved in the research or preparation of this manuscript. This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers. These findings were presented at the Society for Maternal Fetal Medicine 40th Annual Conference 2020 in Grapevine, Texas, February 3, 2020 to February 8, 2020.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Tooba Z. Anwer, Ricardo Aguayo, Anna M. Modest & Ai-ris Y. Collier

  2. Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA

    Tooba Z. Anwer, Anna M. Modest & Ai-ris Y. Collier

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  1. Tooba Z. Anwer
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  2. Ricardo Aguayo
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  4. Ai-ris Y. Collier
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Contributions

TZA was involved in conceptualization, methodology, investigation, and writing of the original draft. RA was involved in investigation, review of writing, and editing of writing. AM was involved in validation, formal analysis, review of writing, and editing of writing. AYC was involved in conceptualization, methodology, investigation, review of writing, editing of writing, and supervision. All authors approved the final version to be published and agree to be accountable for all aspects of the work.

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Correspondence to Ai-ris Y. Collier.

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Anwer, T.Z., Aguayo, R., Modest, A.M. et al. Reexamining intrapartum glucose control in patients with diabetes and risk of neonatal hypoglycemia. J Perinatol 41, 2754–2760 (2021). https://doi.org/10.1038/s41372-021-01292-3

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