Transactions of The Twenty-Second Annual Meeting of The Society for Maternal-Fetal Medicine
Rate and risk factors of hypoglycemia in large-for-gestational-age newborn infants of nondiabetic mothers

Presented at the Twenty-second Annual Meeting of the Society for Maternal-Fetal Medicine, New Orleans, La, January 14-19, 2002.
https://doi.org/10.1067/mob.2002.126962Get rights and content

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, ≤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 ≥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 ≥180 mg/dL markedly increases the risk of neonatal hypoglycemia. (Am J Obstet Gynecol 2002;187:913-7.)

Section snippets

Study population and treatment of neonatal hypoglycemia

The study population consisted of all consecutive LGA infants who were born at the Department of Obstetrics of Vivantes Medical Center, during the 5-year period between 1994 and 1998. Current German birth weight percentiles were used to define LGA neonates (birth weight, >90th percentile).9 LGA newborns were identified in retrospect on the basis of a permanent institutional database that contains mandatory records of each delivery. Infants with major congenital anomalies were excluded.

A

Results

A total of 16,908 infants were born during the study period; 1210 infants (7.1%) were found to be LGA. Seventy-four infants were excluded because of prematurity, 180 infants were excluded because of known GDM or preexisting diabetes mellitus of the mothers, and 69 infants were excluded because of a missing measurement of neonatal glucose. Maternal and neonatal characterics of infants who were excluded because of missing glucose measurements did not differ significantly from those of the infants

Comment

To our knowledge, this is the largest published study that specifically investigated the incidence and risk factors of hypoglycemia in LGA newborn infants from nondiabetic mothers. Our study has three major findings. First, hypoglycemia occurred in 16% of these infants. Second, most infants were diagnosed within the first 5 hours of life. Third, the 1-hour postchallenge glucose value of the maternal oGTT was found to be the only useful predictor for neonatal hypoglycemia. A single abnormal oGTT

References (18)

There are more references available in the full text version of this article.

Cited by (52)

  • Strategies to improve neurodevelopmental outcomes in babies at risk of neonatal hypoglycaemia

    2021, The Lancet Child and Adolescent Health
    Citation Excerpt :

    Other risk factors include neonatal illness (such as birth asphyxia or sepsis) and poor feeding. Babies who are born large for gestational age after a non-diabetic pregnancy are also at risk of neonatal hypoglycaemia.28 It is unknown if hypoglycaemia in these babies is pathological, since there is little evidence that they are at increased risk of long-term neurodevelopmental impairment.29

  • Short- and Long-Term Outcomes Associated with Large for Gestational Age Birth Weight

    2021, Obstetrics and Gynecology Clinics of North America
    Citation Excerpt :

    Among LGA infants of women without diabetes, hypoglycemia occurred in 10.5% and seizures possibly related to hypoglycemia occurred in 0.2% of these infants.29 In another large case series of 887 LGA infants (birth weight of >90th percentile) born to women without diabetes, 16% had hypoglycemia (blood glucose level of <40 mg/dL) during the first 24 hours of life.30 These data highlight the importance of routine postdelivery glucose monitoring in infants with LGA birth weight.

  • Pathophysiology and Management of Disorders of Carbohydrate Metabolism and Neonatal Diabetes

    2020, Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical Management
  • Pathophysiology and Management of Disorders of Carbohydrate Metabolism and Neonatal Diabetes

    2019, Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical Management
  • Incidence of hypoglycemia in newborns at risk and an audit of the 2011 American academy of pediatrics guideline for hypoglycemia

    2018, Pediatrics and Neonatology
    Citation Excerpt :

    Although several studies support this hypothesis, other studies showed no difference in hypoglycemia incidence to that of healthy term AGA infants.7,8 In a large-scale study supporting routine glucose monitoring, Schaefer et al.12 found that 16% of LGA infants had blood glucose level of ≤30 mg/dL in the first 24 h, and this rate dropped rapidly in the first few hours. In their study hypoglycemia incidence was 9.2% in the first hour, 3.5% in 2–5 h and 2.4% later.

  • Glucose

    2018, Volpe's Neurology of the Newborn
View all citing articles on Scopus

Reprints not available from the authors.

View full text