Rate and risk factors of hypoglycemia in large-for-gestational-age newborn infants of nondiabetic mothers.

Abstract

OBJECTIVE:

The purpose of this study was to investigate the rate of hypoglycemia in large-for-gestational-age infants of nondiabetic mothers in relation to maternal or neonatal risk factors.

STUDY DESIGN:

Hospital charts of all term large-for-gestational-age infants born between 1994 and 1998 (n = 1136) were analyzed for the rate of neonatal hypoglycemia (capillary glucose level, < or =30 mg/dL) during the first 24 hours of life. Infants of women with preexisting or gestational diabetes mellitus were excluded (n = 180). Neonatal glucose testing was performed at 1 or 2 hours of life, with subsequent measurements every 4 to 6 hours. Maternal and neonatal parameters were compared between neonates with and without hypoglycemia, including recent oral glucose tolerance test values in those women who were tested (n = 358).

RESULTS:

Of 956 infants, 69 infants (7.2%) were not tested for hypoglycemia. In the remaining 887 infants, hypoglycemia occurred in 142 infants (16%) within the first 24 hours of life. The incidence of hypoglycemia decreased sharply during the first few hours of life, from 9.2% within the first hour of life, to 3.5% between 2 to 5 hours (cumulative) of life, and 2.4% between 6 and 24 hours of life. Gestational age at delivery was the only neonatal parameter that differed significantly between infants with and without hypoglycemia (39.5 vs 39.3 weeks, P =.01). The antenatal 1-hour oral glucose tolerance test value was the only predictive maternal parameter (141.5 vs 163.0 mg/dL, P <.006). There was an incremental risk of hypoglycemia with increasing 1-hour oral glucose tolerance test values, with hypoglycemia rates of 2.5%, 9.3%, 22.0%, and 50.0% that were associated with maternal 1-hour glucose values of <120, 120-179, 180-239, and > or =240 mg/dL, respectively (P <.05, for all comparisons).

CONCLUSION:

Routine glucose testing is indicated in large-for-gestational-age newborn infants of nondiabetic mothers. The 1-hour glucose value of the maternal oral glucose tolerance test is a fairly good predictor of subsequent neonatal hypoglycemia. A single elevated 1-hour value of > or =180 mg/dL markedly increases the risk of neonatal hypoglycemia.

• Authors: Ute M Schaefer-Graf, Rainer Rossi, Christoph Bührer, Gerda Siebert, Siri L Kjos, Joachim W Dudenhausen, Klaus Vetter
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 187 Issue 4 Pg. 913-7 (Oct 2002) ISSN: 0002-9378 [Print] United States
• PMID: 12388976 (Publication Type: Journal Article)

Chemical References

• Blood Glucose

Topics

• Adult
• Aging (blood)
• Blood Glucose (analysis)
• Female
• Fetal Macrosomia (complications)
• Gestational Age
• Glucose Tolerance Test
• Humans
• Hypoglycemia (blood, epidemiology, etiology)
• Incidence
• Infant, Newborn
• Parturition
• Pregnancy
• Prenatal Care
• Risk Factors