Abstract
INTRODUCTION: To determine the demographic, obstetrical, intrapartum and perinatal factors associated with neonatal hypoglycemia. METHODS: Of singleton pregnancies delivered at term in 2013; 318 (3.8%) neonates diagnosed with hypoglycemia were compared to 7955 (96.2%) neonate controls. Analysis utilized Chi-square, student T test and regression analysis. RESULTS: Prenatal factors associated with neonatal hypoglycemia included BMI >35, lower gestational age, and hypertensive disorders, while gestational diabetes was associated with a lower risk. Intrapartum factors increasing risk of neonatal hypoglycemia included labor induction, minimal FHR variability, gentamycin or clindamycin use in labor, lower Bishop scores, and cesarean section. Mothers of neonates with hypoglycemia had more blood loss and longer hospital stays. Neonates with hypoglycemia were more likely to be SGA, had umbilical cord gases that trended towards acidosis, more birth defects with more admission to NICU. Other neonatal morbidities associated with hypoglycemia included: nutritional disorders (15.4%), birth defects (13.5%), pulmonary disease (10.6%), hematologic conditions (5.7%), hypoxic encephalopathy (4.7%) and electrolyte abnormalities/dehydration (3.5%). Regression analysis showed that independent predictors of neonatal hypoglycemia were SGA (P=.000, odds ratio [OR]=10.05), minimal FHR variability (P=.015, OR=1.53), birth defects (P=.017, OR=2.56), and cesarean section (P=.016, OR=1.58) while gestational diabetes was independently protective (P=.012, OR=0.077). CONCLUSION: Contrary to expectations, diabetes was protective of neonatal hypoglycemia, which can be explained by the optimum obstetrical management of diabetes. Given that neonatal hypoglycemia is associated with significant morbidity; measures to prevent SGA, the major predictive risk factor and the other predictors of birth defects, intrapartum fetal stress, and cesarean sections may be useful.
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