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Association of intrapartal maternal blood glucose control and neonatal hypoglycemia in a private tertiary hospital

By Maria Edwardina G. De Leon, MD; Zarinah R. Gonzaga, MD, FPOGS
Department of Obstetrics and Gynecology, The Medical City

Objective: Diabetes in pregnancy is associated with maternal and fetal risks that include maternal hyperglycemia and neonatal hypoglycemia. Intrapartal plasma glucose concentration has a stronger association with decreased neonatal hypoglycemia paralleled with antepartum plasma glucose levels. The objective of the study is to determine the association between intrapartal glucose monitoring and neonatal hypoglycemia.

Methods: This is a retrospective cohort study that involves parturients of any age with term gestation (>37 weeks) with gestational type or overt type of diabetes mellitus, either insulin-requiring or on medical nutrition therapy, with or without mean capillary blood glucose levels during labor. Multiple logistic regression was used for analysis, which quantifies the magnitude of association between maternal blood glucose control and neonatal hypoglycemia adjusted for significant confounders.

Results: The incidence of diabetes among pregnants in this private tertiary hospital over the study period was 7.82%. Most of the diabetic parturients were primigravid, with gestational type of diabetes mellitus, and on medical nutrition therapy. More than half were referred to an endocrinologist intrapartum. The incidence of maternal hyperglycemia intrapartum is 33%. The birthweights of the neonates ranged from 2095 to 5250 grams. Among the diabetic parturients, the incidence of neonatal hypoglycemia is 10%. There was no significant association between neonatal hypoglycemia and intrapartummaternal hyperglycemia (p=0.05).

Conclusion: There is no significant association between intrapartum maternal hyperglycemia and development of neonatal hypoglycemia. Antepartum and intrapartum management of maternal hyperglycemia did not appear to be associated with the development of neonatal hypoglycemia. A standardized institutional management protocol on glucose monitoring and control among diabetic parturients is strongly suggested.