353: Determinants of neonatal hypoglycemia in women with type II and gestational diabetes mellitus

Abstract

GESTATIONAL DIABETES MELLITUS GLADYS RAMOS, ALETHEA HANLEY, JENNIFER AGUAYO, CARRI WARSHAK, THOMAS MOORE, University of California, San Diego, San Diego, California, University of California, San Diego, California OBJECTIVE: To determine the risk factors associated with neonatal hypoglycemia in neonates of mothers with Type II and gestational diabetes mellitus (GDM). STUDY DESIGN: A retrospective study was performed evaluating neonates of Type II and GDM women treated with diet, glyburide and insulin. Maternal characteristics, glycemic control, and neonatal hypoglycemia were assessed. Statistical methods included bivariate analyses. RESULTS: In 2001-2004, 259 mother and neonate pairs were identified. Sixtyeight (26%) were treated with diet, 110 (42%) with glyburide, and 81 (31%) with insulin. The incidence of neonatal hypoglycemia (capillary blood sugar 45mg/ dL) was 20% (51/259). The incidence was significantly lower in the diet treated group (3%, 2/68, p 0.001) when compared to the glyburide (24%, 26/110) and insulin (28%, 23/81) groups. The rate of neonatal hypoglycemia between the glyburide and insulin groups did not vary with diabetes type (type II diabetics (35%) vs. A2 GDM (22%), p 0.07) or medication type (glyburide (24%) vs. insulin (28%), p 0.50). Mean fasting and postprandial values at 36 weeks (fasting 90.3 15 vs. 92.1 14, p 0.30 and postprandial 13.7 22 vs. 130.7 26, p 0.11) and during the last week of pregnancy (fasting 86.5 11 vs. 89.4 15, p 0.33 and postprandial 127.4 16 vs. 124 24, p 0.35) did not differ between glyburide and insulin groups. Neonatal hypoglycemia was associated with macrosomia (p 0.001) and the incidence progressively increased with increasing birth weight (p 0.003). The rate of macrosomia did not vary between treatment groups (diet 15% vs. pharmacotherapy 19%, p 0.47 or glyburide 16% vs. insulin 24%, p .27). Macrosomia was significantly associated with maternal body mass index upon presentation to prenatal care (p 0.005). CONCLUSION: Women with type II and GDM treated with glyburide and insulin have a higher incidence of neonatal hypoglycemia than diet treated patients. A strong determinant for the development of neonatal hypoglycemia was macrosomia. Macrosomia itself was strongly associated with maternal obesity.