Incidence Of Neonatal Hypoglycemia Research Articles

Does the 3C (Counselling, Checking and Certification) Initiative Prevent Hypoglycemia Among At-Risk Stable Late Preterm and Term Neonates? - A Randomized Controlled Trial.

To evaluate whether the 3C (Counselling, Checking, Certification) initiative helps in preventing hypoglycemia among at-risk neonates compared to standard care. This randomised controlled trial included 222 mother-newborn dyads with risk factors for neonatal hypoglycemia-Small for gestational age (SGA) babies, infants of diabetic mothers (IDM), large for gestational age (LGA) babies and late preterm infants (LPI). They were randomized to two groups. Group A received standard care while mothers in group B were administered 3C intervention. Early initiation of breastfeeding, incidence of neonatal hypoglycemia within 24h, and exclusive breastfeeding rate at 6 mo were evaluated. Early initiation of breastfeeding was higher in the 3C group compared to standard care group (94.6% vs. 55.9% p <0.001). The incidence of hypoglycemia within 24h was lower in the intervention group compared to standard care (3.6% vs. 15.3%, p <0.05). However, there was no significant difference in exclusive breastfeeding rates at 6 mo between the two groups (61% and 66% in group A and B respectively). The 3C intervention decreases the incidence of hypoglycemia among at-risk neonates. Early initiation of breast-feeding is higher among mothers who receive the 3C intervention.

Association between pregnant women fasting duration and neonatal hypoglycemia: A prospective cohort study.

To evaluate the association between maternal fasting time before delivery and the occurrence of hypoglycemia in neonates immediately after birth. This prospective single-center cohort study included pregnant women who delivered at the study institution between October 2021 and January 2023 and their neonates. The primary outcome was the incidence of neonatal hypoglycemia after birth, defined as a blood glucose level less than 47 mg/dL. Fasting time was categorized into quartiles, and the association between maternal fasting time and neonatal hypoglycemia was investigated. The crude or adjusted odds ratios of maternal fasting time for neonatal hypoglycemia were calculated using logistic regression analysis. The study included 663 pregnant women and 696 neonates. Compared with the reference group with a short fasting time of 4.3 h or less, the adjusted odds ratios for neonatal hypoglycemia were 1.47 (95% confidence interval [CI] 0.70-3.20) for middle fasting time (4.3-9.8 h), 4.05 (95% CI 2.02-8.56) for long fasting time (9.8-14.6 h), and 4.99 (95% CI 2.59-10.25) for very long fasting time (>14.6 h). In the subgroup analysis, the association between maternal fasting time and neonatal hypoglycemia showed different trends according to the mode of delivery. Maternal fasting time over 9-10 h before delivery was associated with the occurrence of neonatal hypoglycemia. Obstetrical management, considering not only maternal safety but also neonatal hypoglycemia prevention, is required.

Neonatal hypoglycemia and associated factors at Wangaya General Hospital

In the early hours to early days of life, managing low blood glucose levels and screening infants at risk are common problems in the care of newborns. Still missing, though, is a precise definition of newborn hypoglycemia. The purpose of this study is knowing that pregnancy hypertension/preeclampsia/eclampsia, prematurity, small-gestational-weight (SGA), large-gestational-weight (LGA), asphyxia, and sepsis are risk factors associated with neonatal hypoglycemia. The type of research conducted was a cross-sectional retrospective analytic study on infants in the perinatology room at Wangaya Hospital in 2022. The sample in this study consisted of 18 hypoglycemia babies and 18 normoglycemia babies taken by purposive sampling with matching hypertension/preeclampsia/eclampsia pregnancy, prematurity, SGA, LGA, asphyxia and sepsis. Data collection used medical record data and perinatology register data. Statistical tests used were Chi-Square and logistic regression with a 95% confidence interval. The results showed that prematurity was an associated risk factor (OR=2.78; 95% CI=1.437-5.379), asphyxia and sepsis also showed statistical significance (OR=2.07; 95% CI=1.221-3.513) (OR=2.27; 95% CI=1.257-4.109). In multivariate analysis, there was no statistical significance among other factors (p-value 0.019). Prematurity, asphyxia, and sepsis were risk factors associated with the incidence of neonatal hypoglycemia with odds of 2.78 times, 2.07 times and 2.27 times respectively compared to the control population. However, in the multivariate analysis, there was no relationship between one factor to another factor that influenced each other in being a risk factor associated with hypoglycemia at Wangaya Hospital.

Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis

BackgroundSkin-to-skin contact between mother and infant after birth is recommended to promote breastfeeding and maternal-infant bonding. However, its impact on the incidence of neonatal hypoglycaemia is unknown. We conducted a systematic review and meta-analysis to assess this.MethodsPublished randomised control trials (RCTs), quasi-RCTs, non-randomised studies of interventions, cohort, or case–control studies with an intervention of skin-to-skin care compared to other treatment were included without language or date restrictions. The primary outcome was neonatal hypoglycaemia (study-defined). We searched 4 databases and 4 trial registries from inception to May 12th, 2023. Quality of studies was assessed using Cochrane Risk of Bias 1 or Effective Public Health Practice Project Quality Assessment tools. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results were synthesised using RevMan 5.4.1 or STATA and analysed using random-effects meta-analyses where possible, otherwise with direction of findings tables. This review was registered prospectively on PROSPERO (CRD42022328322).ResultsThis review included 84,900 participants in 108 studies, comprising 65 RCTs, 16 quasi-RCTs, seven non-randomised studies of intervention, eight prospective cohort studies, nine retrospective cohort studies and three case–control studies. Evidence suggests skin-to-skin contact may result in a large reduction in the incidence of neonatal hypoglycaemia (7 RCTs/quasi-RCTs, 922 infants, RR 0.29 (0.13, 0.66), p < 0.0001, I2 = 47%). Skin-to-skin contact may reduce the incidence of admission to special care or neonatal intensive care nurseries for hypoglycaemia (1 observational study, 816 infants, OR 0.50 (0.25–1.00), p = 0.050), but the evidence is very uncertain. Skin-to-skin contact may reduce duration of initial hospital stay after birth (31 RCTs, 3437 infants, MD -2.37 (-3.66, -1.08) days, p = 0.0003, I2 = 90%, p for Egger’s test = 0.02), and increase exclusive breastmilk feeding from birth to discharge (1 observational study, 1250 infants, RR 4.30 (3.19, 5.81), p < 0.0001), but the evidence is very uncertain.ConclusionSkin-to-skin contact may lead to a large reduction in the incidence of neonatal hypoglycaemia. This, along with other established benefits, supports the practice of skin-to-skin contact for all infants and especially those at risk of hypoglycaemia.

Pre-labour Rupture of Membranes at Term in Women With Gestational Diabetes and the Risk of Neonatal Hypoglycemia

ObjectivesThe management for improving maternal and neonatal outcomes of women with gestational diabetes mellitus (GDM) arriving at the delivery ward with pre-labour rupture of membranes (PROM) has not been elucidated. We tested the hypothesis that prolonged PROM in women with GDM would result in higher rates of neonatal hypoglycemia. MethodsWe retrospectively enrolled women with diet or insulin-controlled GDM who presented with spontaneous clear PROM. Each woman was allocated into one of two groups based on the PROM-delivery time: <18 hours (group 1) and ≥18 hours (group 2). The primary outcome was the incidence of neonatal hypoglycemia, defined as glucose <40 mg/dL (2.2 mmol/L) within 24 hours of birth. ResultsWe ultimately analyzed 631 cases of GDM (6.7%), 371 with PROM-delivery <18 hours, and 260 with PROM-delivery ≥18 hours. The incidence of neonatal hypoglycemia did not differ between the two groups, reaching 7.3%. Women in group 2 were at increased risk of both cesarean delivery (20% vs. 12.4%, P < 0.01) and maternal chorioamnionitis morbidity (6.5% vs. 1.3%, P < 0.001). ConclusionsIn a sub-group of women with GDM, a PROM-delivery time ≥18 hours is not associated with higher rates of neonatal hypoglycemia, but higher rates of chorioamnionitis and cesarean delivery were noted. Therefore, we suggest consideration for early delivery when managing women with GDM and PROM.

Analysis of risk factors of neonatal hypoglycemia and its correlation with blood glucose control of gestational diabetes mellitus: A retrospective study.

This study aimed to investigate the risk factors associated with neonatal hypoglycemia and its correlation with blood glucose control in patients with gestational diabetes mellitus (GDM). This study was a retrospective study. 880 pregnant women with GDM and their newborns were hospitalized from January 2018 to December 2022 in our hospital. The clinical information of GDM pregnant women and their newborns were reviewed and the hemoglobin A1c (HbA1c) values measured within 1 week before delivery were collected. According to the occurrence of neonatal hypoglycemia, which was divided into the control and observation groups. Logistic regression model was used to estimate the potential factors associated with neonatal hypoglycemia. The association between HbA1c of pregnant women before delivery and abnormal glucose metabolism in newborns was examined using spearman correlation analysis. A total of 104 cases of hypoglycemia occurred in neonates delivered by 880 GDM women and the incidence of neonatal hypoglycemia was 11.82%. There were significant differences in pre-pregnancy overweight or obesity, delivery mode, maternal blood sugar control effect and neonatal feeding standard between the 2 groups of GDM women (P < .05). Pre-pregnancy overweight or obesity, poor blood sugar control in GDM women, and improper neonatal feeding were risk factors for neonatal hypoglycemia. The results of logistic regression analysis showed that abnormal glucose metabolism in newborn (odds ratio [OR]: 2.43, 95% confidence interval [CI]: 1.12-4.73) and neonatal hypoglycemia (OR: 3.04, 95% CI: 1.33-5.79) were a risk factor. We also conducted the logistic analysis to evaluate the correlation between HbA1c before delivery and abnormal glucose metabolism in newborns of pregnant women with GDM through adjusting some potential factors. The results were still significant in the abnormal glucose metabolism in newborn (OR: 2.84, 95% CI: 1.23-6.63) and neonatal hypoglycemia (OR: 3.64, 95% CI: 1.46-8.18). Overweight or obesity of GDM parturient before pregnancy, poor blood glucose control of GDM parturient and improper feeding of newborns are all risk factors for neonatal hypoglycemia. HbA1c before delivery has a certain predictive value for abnormal glucose metabolism in newborns.

Corticosteroids to safely reduce neonatal respiratory morbidity after late preterm and term planned caesarean section birth? A randomised placebo-controlled feasibility study

ObjectivesTo assess the feasibility of conducting a randomised placebo-controlled trial of corticosteroids prior to planned caesarean section from 35+0 to 39+6 weeks.DesignA triple-blind, placebo-controlled, parallel, trial randomised at the participant...

Neonatal hypoglycemia in infants born to mothers with gestational diabetes mellitus. Comparison of its incidence based on maternal treatment.

Neonatal hypoglycemia is a complication of gestational diabetes mellitus. Few studies have been conducted to support a systematic screening in the first hours of life of this population group. To assess the association between the treatment administered to the mother (diet vs. insulin) and the development of hypoglycemia, and to identify associated risk factors. Observational, analytical, and retrospective study carried out at the Buenos Aires and San Justo maternal centers of a general, tertiary care hospital between 01-01-2017 and 12-31-2018. The incidence of neonatal hypoglycemia (≤ 47 mg/dL) based on the management of maternal diabetes was estimated and a multivariate analysis was done to assess related factors. A total of 195patients were included. No statistical difference was found in the incidence of hypoglycemia based on the treatment administered to the mother (45.3% vs. 39.7%; p = 0.45) and no associated risk factors were identified. Once the cutoff point was changed to ≤ 40 mg/dL, no differences were found in the incidence either (23.4% versus 19%, p = 0.48); however, patients with hypoglycemia had a significantly higher hematocrit level and a lower prevalence of exclusive breastfeeding upon discharge. Multivariate analysis showed an independent association between a high birth weight and hypoglycemia, requiring correction. The incidence of neonatal hypoglycemia in the studied population did not vary based on the treatment received by the mother. This study supports the control of glycemia in these infants in daily practice.

Comparison of neonatal and maternal outcomes of anti-diabetic drugs in the treatment of gestational diabetes mellitus: Findings from Bayesian network meta-analysis.

ABSTRACTThe safety and efficacy of different anti-diabetic drugs are not clear because of the lack of sufficiently powered clinical trials. This network meta-analysis was conducted to compare the efficacy and safety of three anti-diabetic drugs (insulin, glyburide, and metformin), and rank them as per their efficiency to control glucose levels, pregnancy, and neonatal outcomes. The study design is a systematic review, meta-analysis, and network meta-analysis. After a systematic search of existing databases, 34 randomized controlled trials were selected for inclusion in the analysis. We did pairwise network meta-analysis to calculate standardized mean difference and odds ratio (OR) as the summary measures for numerical and dichotomous variables, respectively, by using random-effects model. Our key outcomes were incidence of neonatal hypoglycemia, respiratory distress syndrome, macrosomia, C-section, admission to neonatal intensive care unit (NICU) and mean differences in the birth weight of neonates, gestational age at birth, HbA1C levels, fasting blood sugar, large at gestational age, and post-prandial glucose. It was found that metformin significantly lowered the post-prandial levels of glucose as compared with both glyburide and insulin in pairwise analysis (SMD = 14.11 [23–4.8]; SMD = 22.45 [30–14]), respectively. There was a significant reduction in birth weights of babies whose mothers were administered metformin as compared with either glyburide or insulin. The proportion of neonates admission to NICU was significantly lower for metformin when compared with insulin [Log OR = 0.334 (0.0184, 0.6814))]. Large at gestational age was significantly lower for metformin as compared with both glyburide and insulin [log OR = 0.6882 (0.171, 1.329), log OR = 0.393 (0.00179, 0.8218)], respectively. Oral anti-diabetic drugs especially metformin performed better than both glyburide and insulin for all neonatal and maternal outcomes except that it significantly lowered the neonatal birth weight.

Maternal Hyperglycemia and Neonatal Hypoglycemia Following Betamethasone Administration in Non-Diabetic Women

To determine the incidence and duration of maternal hyperglycemia following betamethasone administration in non-diabetic pregnant women and the incidence of neonatal hypoglycemia in those patients delivered within 7 days of betamethasone.

Maternal Hyperglycemia and Neonatal Hypoglycemia Following Betamethasone Administration in Diabetic Women

To determine the incidence and duration of maternal hyperglycemia following betamethasone administration in diabetic pregnant women, and the incidence of neonatal hypoglycemia in those delivered within 7 days of betamethasone.

Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing.

To determine the factors associated with neonatal hypoglycemia among neonates exposed to antenatal corticosteroid (ACS). A retrospective study conducted during 2017-2019 at a tertiary-care center including all neonates delivered between 24 and 34weeks of gestation after ACS administration. The primary outcome was neonatal hypoglycemia (<40mg/dl). Overall, 362 early preterm neonates, including 205singletons and 157 twins, were exposed to ACS before delivery and constituted the study group. Of them, 275 (76.0%) were exposed to a single ACS course and 87 (24.0%) to an additional rescue ACS course. Neonatal hypoglycemia occurred in 84 (23.2%) neonates. The incidence of neonatal hypoglycemia was significantly higher in those delivered between 24 and 48h after ACS administration compared with those delivered outside this time interval (10/25, 40.0% vs 74/337, 21.9%; P=0.049). In multivariate analysis, after adjusting for neonatal birth weight and gestational age, delivery within 24-48h after ACS administration was the only independent risk factor associated with neonatal hypoglycemia (adjusted odds ratio 2.41, 95% confidence interval 1.03-5.68; P=0.044). Neonatal hypoglycemia occurred in over one-fifth of those exposed to ACS, and was independently associated with delivery between 24 and 48h after ACS administration.

Are newly introduced criteria for the diagnosis of gestational diabetes mellitus associated with improved pregnancy outcomes and/or increased interventions in New South Wales, Australia? A population-based data linkage study

IntroductionThe incidence of gestational diabetes mellitus (GDM) is increasing in Australia, influenced by changed diagnostic criteria. We aimed to identify whether the diagnostic change was associated with improved outcomes and/or...

604 Clinical indications for antenatal late preterm steroids affect neonatal hypoglycemia

Antenatal Late Prenatal Steroids (ALPS) may reduce the incidence of neonatal respiratory disorders, though exposure is associated with higher rates of hypoglycemia. Our objective was to evaluate the relationship between clinical factors surrounding use of ALPS and the incidence of neonatal hypoglycemia. A retrospective chart review of records identified patients who received ALPS and all late preterm deliveries (LPTD) at 34 0/7-34 6/7 weeks from 2017 to 2019. Clinical and demographic information was obtained. Neonatal hypoglycemia was defined as point-of-care glucose <40mg/dL during admission. Pregnancies with and without neonatal hypoglycemia were compared using Student t test, and Fisher’s exact test. A p-value <0.05 was considered statistically significant. We identified 272 patients who received ALPS. Of those, 146 (53.7%) received it due to risk of indicated preterm birth and 126 (46.3%) due to risk of spontaneous preterm birth. The rate of preterm delivery was 57.4%. In those delivering at <37 weeks, 78.2% delivered within 48-hours. Hypoglycemia was diagnosed in 71 newborns (26.1%), and was more common in preterm vs. term births (37.2% vs. 11.2%; p<.001). Table 1 compares the cohorts of preterm births with and without neonatal hypoglycemia. Gestational age at delivery and birthweights were similar. Rates of neonatal hypoglycemia were increased when delivery occurred ≥48-hours after the first-dose of steroids (31.0% vs. 16.3%; p=0.04). Hypoglycemia was less common in preterm births who delivered within 48-hours of ALPS (32.8% vs. 52.9%; p=0.04). Neonatal respiratory disorders (RDS or TTN) were more common in those delivering within 48-hours (33.6% vs. 14.7%; p=0.04) compared to those who delivered ≥48-hours after first-dose. In those receiving ALPS, hypoglycemia was common in late preterm births. The highest rate was in preterm births >48-hours after administration of first-dose. As this corresponded to lower rates of neonatal respiratory disorders, the risk and benefit of ALPS appear to coincide in this group of patients.

Safety and feasibility of oral carbohydrate consumption before cesarean delivery on patients with gestational diabetes mellitus: A parallel, randomized controlled trial.

To investigate the safety and feasibility of taking low-concentration carbohydrate solution at 2 h before induction of anesthesia for gestational diabetes mellitus (GDM) patients. GDM patients undergoing cesarean section were randomly assigned to experimental group (n = 43) and control group (n = 42). Two hours before induction of anesthesia, participants in experimental group orally received 300 mL low-concentration carbohydrate solution, while those in control group received equivalent warm water. Blood glucose and serum insulin were measured at 2 h before induction of anesthesia, right before induction of anesthesia, and the morning of postoperative day 1. Neonatal blood glucose level was monitored at birth. Maternal gastrointestinal function and well-being were assessed perioperatively. The levels of blood glucose and serum insulin right before induction of anesthesia in the experimental group were significantly higher than those in the control group. There were four cases with hypoglycemia in the experimental group and 19 cases in the control group right before induction of anesthesia (9.3% vs 45.2%, p < 0.001). The incidence of neonatal hypoglycemia was 2.3% in the experimental group and 7.1% in the control group with no significance. Hunger score of the participants between the two groups right before induction of anesthesia was significantly different. No aspiration, nausea, and vomiting occurred in both groups before, during, and after surgery. No significant difference was found in the time to the first flatus and abdominal distension between the two groups. Taking low-concentration carbohydrate solution is safe and feasible for patients with GDM undergoing elective cesarean section.

Efficacy and safety of the pregnancy-IVI, an intravenous insulin protocol for pregnancy, following antenatal betamethasone in type 1 and type 2 diabetes.

Hyperglycaemia following antenatal corticosteroids is common in women with diabetes in pregnancy, and validated algorithms to maintain pregnancy-specific glucose targets are lacking. The Pregnancy-IVI, an intravenous-insulin (IVI) algorithm, has been validated in gestational diabetes; however, its performance in pre-existing diabetes (Type 1 and Type 2 diabetes) is not known. We hypothesised that Pregnancy-IVI would be superior to a generic Adult-IVI protocol (prior standard of care) following betamethasone in women with pre-existing diabetes. A retrospective cohort study enrolled all women with pre-existing diabetes at a tertiary centre receiving betamethasone and treated with IVI according to one of two protocols: Adult-IVI (n=73, 2014-2017) or Pregnancy-IVI (n=62, 2017-2020). The primary outcome was on-IVI glycaemic time-in-range (capillary blood glucose (BGL) 3.8-7.0mmol/L). Secondary outcomes included time with critical hyperglycaemia (BGL>10mmol/L); occurrence of maternal hypoglycaemia (BGL<3.8mmol/l) and incidence of neonatal hypoglycaemia (BGL≤2.5mmol/L). Analysis was stratified by diabetes type. Overall, Pregnancy-IVI achieved a higher proportion of on-IVI time-in-range (70%, IQR 56-78%) compared to Adult-IVI (52%, IQR 41-69%, p<0.0001). The duration of critical hyperglycaemia with Pregnancy-IVI was also reduced (2% [IQR 0-7] vs 8% [IQR 4-17], p<0.0001), without an increase in hypoglycaemia. Glycaemic variability was significantly reduced with Pregnancy-IVI. No difference in the rate of neonatal hypoglycaemia was observed. The Pregnancy-IVI was most effective in women with Type 1 diabetes. The Pregnancy-IVI algorithm is safe and effective when used following betamethasone in type 1 diabetes in pregnancy. Further study of women with type 2 diabetes is required.

Antenatal betamethasone and the risk of neonatal hypoglycemia: it's all about timing.

Our objective was to evaluate whether there is a relationship between the "time during the day" of maternal betamethasone administration between 24 and 34weeks' gestation and the risk for neonatal hypoglycemia. A retrospective study included cases between 2008 and 2018. Eligible cases were pregnant women with singleton pregnancies who received a single course of betamethasone between 24 and 34weeks' gestation. Each woman was allocated into one of four pre-defined groups based on the time when intramuscular betamethasone was administered. Group 1 (23:00-04:59) represents the lowest daily natural corticosteroids' activity, group 2 (05:00-10:59) represents the peak daily natural corticosteroids' activity, whereas group 3 (11:00-16:59) and group 4 (17:00-22:59) present an intermediate natural state of steady corticosteroids' secretion and activity. The primary outcome of the study was the incidence of neonatal hypoglycemia (glucose level of less than 40mg/dL). We have identified 868 women who received a single complete course of betamethasone, of which 353 women (40.7%) had a steroid treatment latency to delivery up to 14days. The incidence of neonatal hypoglycemia was significantly higher in group 2 (39.5%, 30/76, p = 0.0063), compared to group 1, who had the lowest incidence of neonatal hypoglycemia (16.9%, 12/71), and to group 3 and group 4. The "time during the day" when betamethasone administered is important when considering the risk for neonatal hypoglycemia. The risk was significantly higher when betamethasone was administered during the peak time and significantly lower when administered at the nadir time of maternal endogenous corticosteroid activity.

194-OR: Impaired Awareness of Hypoglycemia and Maternal/Neonatal Outcomes in the CONCEPTT Trial

Background: Patients with diabetes and impaired awareness of hypoglycemia (IAH) are at increased risk of severe hypoglycemia (SH). IAH is increased during pregnancy. To date, maternal and neonatal outcomes of pregnant women with hypoglycemia unawareness or SH has not been well described. Aim: To examine maternal and neonatal outcomes in women with IAH compared to women with normal awareness of hypoglycemia (NAH). Methods: We included 214 pregnant women with type 1 diabetes who participated in the CONCEPTT trial. Participants completed Hypoglycemia Fear Surveys (HFS-II) at baseline and study completion. Post-hoc analysis of data was conducted using logical regression analysis to estimate the odds of occurrence of events by IAH versus NAH. The role of continuous glucose monitoring (CGM) use on outcomes was also examined. Results: Overall, 30% of participants reported IAH (n=64). Women with IAH had more episodes of SH during pregnancy (mean 0.44 vs. 0.08, p&amp;lt;0.001). Women with IAH scored significantly higher on the HFS-II worry scale (25.9 vs. 20.1, p 0.0036), indicating more fear of hypoglycemia at baseline. They also spent more time below range (&amp;lt;63 mg/dl) at 12 weeks gestation. Higher overall HFS-II scores were associated with a higher risk of maternal SH episodes (RR 1.78, 95% CI 1.39-2.27) and a lower incidence of neonatal hypoglycemia (OR 0.597, 95% CI 0.385-0.893). There were no other differences in obstetric/neonatal outcomes between women with IAH and NAH. Higher HFS-II scores were associated with more diabetes-related complications, such as nephropathy (OR 1.907, 95% CI 1.06-3.4), independent of duration of diabetes. Finally, CGM did not affect incidence of SH (RR 0.54, 95% CI 0.12 - 2.16). Conclusion: In pregnant women with type 1 diabetes, IAH is associated with more maternal SH episodes and more fear of hypoglycemia. Fear of hypoglycemia was associated with reduced neonatal hypoglycemia as well as more maternal diabetes-related complications. Disclosure J. Bahrami: None. G. Tomlinson: None. H.R. Murphy: Advisory Panel; Self; Medtronic. D. Feig: Advisory Panel; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Medtronic. Funding JDRF; Canadian Clinical Trial Network

The Utility of Lower Glycemic Targets for Treating Gestational Diabetes: A Retrospective Study.

Objective In vivo study of glucose homeostasis in pregnancy suggests normal glucose levels are lower than current glycemic targets used in gestational diabetes. After the HAPO study results, our institution began using glycemic targets of fasting 85 mg/dL and 2-hour postprandial of 110 mg/dL. We reviewed our results. Methods A retrospective cohort of GDM patients that delivered at KUMC from January 2007 to May 2017 was reviewed. All patients were diagnosed with the 2-step Carpenter-Coustan thresholds. High targets were compared with low targets. The primary outcome investigated was birthweight > 90% (large for gestational age, LGA). Results 604 patients were studied, and 34% were treated with low glycemic targets. Our unadjusted results showed that the low-target group had a lower incidence of LGA infants (24.0 vs. 31.8%), higher incidence of neonatal hypoglycemia (20.7 vs. 11.6%), and inductions (39.4 vs. 20.5%). After adjustment for demographic variables, only a higher risk of inductions remained (aOR 2.54 (1.44, 4.49)). Conclusion Lower glycemic targets did not produce large reductions in fetal overgrowth, but they were associated with a higher rate of inductions. As there were no observed differences in maternal or neonatal outcomes otherwise, aiming for lower glycemic targets in GDM is likely not cost-effective.

Incidence and risk factors of neonatal hypoglycemia after ritodrine therapy in premature labor: a retrospective cohort study

BackgroundRitodrine hydrochloride (RD), a β2-adrenergic agonist, is widely used as a tocolytic medication to suppress premature labor, but can cause neonatal hypoglycemia, a potentially severe side effect. We examined the incidence and risk factors of neonatal hypoglycemia following maternal intravenous administration of RD.MethodsThis was a retrospective study of neonates, who had birth weight of ≥2000 g and were delivered at 36 weeks gestation or later in Kanazawa University Hospital from August 2013 to July 2016. We defined neonatal hypoglycemia as blood glucose level < 50 mg/dL. Neonates who were delivered without maternal intravenous RD or who were delivered 8 days or more after stopping maternal RD or who received oral RD were defined as the RD non-administration group, while those delivered within 7 days after stopping maternal RD were defined as the RD intravenous administration group. We examined the incidence and risk factors of RD-induced neonatal hypoglycemia by comparing these two groups.ResultsWe enrolled 603 neonates in this study; 504 (83.6%) showed no neonatal hypoglycemia, while 99 (16.4%) exhibited neonatal hypoglycemia. The incidence of neonatal hypoglycemia was significantly higher (61.7%; 58/94) in the RD intravenous administration group than in the RD non-administration group (8.1%; 41/509) (p < 0.001). Binomial logistic regression analysis in the RD intravenous administration group showed that maternal age over 35 years (AOR: 3.385; 95% CI, 1.082–10.588, p = 0.036) and the interval to delivery from stopping intravenous administration of RD (AOR: 0.974; 95% CI, 0.953–0.996, p = 0.020) were independent factors associated with neonatal hypoglycemia. The cut-off value of the interval to predict the incidence of neonatal hypoglycemia was about 6 h (sensitivity 82.8%, specificity 63.9%).ConclusionsThe incidence of neonatal hypoglycemia was significantly increased by maternal intravenous administration of RD. We newly identified maternal age (over 35 years) and the interval to delivery from stopping intravenous administration of RD (within 6 h) as independent risk factors for neonatal hypoglycemia following maternal intravenous administration of RD. In cases with these risk factors, careful blood glucose monitoring is recommended for early detection and treatment of neonatal hypoglycemia.