What Percent of Diabetoc Babies Have Low Vlood Sugar After Birth

Indian J Endocrinol Metab. 2018 Sep-October; 22(v): 621–626.

Neonatal Glycemic Status of Infants of Diabetic Mothers in a Tertiary Care Hospital

Suraiya Begum

Section of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Sanjoy K. Dey

¹Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Kanij Fatema

^twoDepartment of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical Academy, Dhaka, Bangladesh

Abstract

Background:

Diabetes is a common medical complexity during pregnancy that results in significant neonatal morbidities. In infants of diabetic mothers (IDMs), hypoglycemia is a common complication.

Objective:

To report the neonatal hypoglycemia in IDMs in a third intendance hospital.

Settings and Design:

A cross-sectional report was washed in postnatal ward in Bangladesh Establish of Research and Rehabilitation in Diabetic, Endocrine and Metabolic Disorders from January to December 2009.

Subjects and Methods:

The information of IDMs were nerveless from postnatal ward. All IDMs delivered during this period staying in postnatal ward were included in this study. The outcomes were compared betwixt the hypoglycemic and normoglycemic IDMs and betwixt gestational diabetes mellitus (GDM) and pre-GDM in hypoglycemic group using Chi-square test and Fisher'due south exact exam. The information analysis was performed with Epi-enfo7 software. Statistical significance was gear up at P < 0.05.

Results:

A total of 363 IDMs were included in this study. Hypoglycemia developed in 38.three% IDMs and 43.2% mothers of hypoglycemic IDMs had GDM and 56.8% had pre-GDM. Elapsing of maternal diabetes (P = 0.04) and big for gestational age (P = 0.0001) were associated with hypoglycemia. Multigravidae (82.2% vs 68.3%, P = 0.03), prolonged duration of maternal diabetes (45.46 weeks vs iii.23 weeks, P = 0.00001), preterm babies (48.1% vs 28.3% P = 0.009), and command of diabetes past insulin (81% vs 46.7%, P = 0.001) were more than in pre-GDM, and statistically significant. About 85% IDMs developed hypoglycemia inside 6 h of birth (P-value 0.00001) and majority (68%) were at ii h of historic period. Forty percent of hypoglycemic IDMs from postnatal ward were admitted in special intendance baby unit of measurement.

Conclusion:

Hypoglycemia observed in 38.iii% IDMs and adult within half dozen h of age and maximum were at 2 h. Early recognition and advisable intervention are needed in IDMs.

Keywords: Gestational diabetes mellitus, hypoglycemia, infants of diabetic mothers, pre-gestational diabetes mellitus

INTRODUCTION

Diabetes is a common medical complication in pregnancy. The prevalence of diabetes mellitus (DM) in pregnancy ranges from 1 to 14%.[ane] Information technology may be pre-gestational diabetes mellitus (pre-GDM) or may exist gestational diabetes mellitus (GDM).[2] The Globe Wellness Organization (WHO) has predicted that between 1995 and 2025, there will be a 35% increment in the worldwide prevalence of diabetes.[iii] Moreover, women built-in in Asian countries shows the highest prevalence of GDM, with up to 17% of women likely to develop GDM.[4,5] As the incidence of diabetes continues to rise and increasingly affects individuals of all ages, including young adults and children, women of childbearing age are at increased hazard of diabetes during pregnancy. The prevalence of diabetes in People's republic of bangladesh is 8.i% in urban and 2.3% in rural area.[6] The prevalence of GDM in urban Bangladeshi population is about 7.5%.[7]

Glucose is essential for normal brain cell office. Normal claret glucose (BG) levels in the newborn period ensure proper neurological development.[8] Therefore early detection of hypoglycemia in neonate at risk is of utmost value to prevent the complication arising from neonatal hypoglycemia.[ix] Various factors influence newborn BG concentrations even in healthy term newborns, such every bit birth weight, gestational age, presence or absenteeism of illness, perinatal complications, mode of delivery, and feeding beliefs.[x] Most IDMs are prone to hypoglycemia during the first postnatal hours.[5] The incidence of hypoglycemia is highest at ane–4 h of historic period when in that location is fall in plasma glucose, following the cessation of maternal glucose infusion.[11,12]

Uncontrolled maternal glycemia causes neonatal hypoglycemia as well as transient hyperinsulinemia.[13] In utero, maternal hyperglycemia increases placental glucose transport and results in fetal hyperglycemia, which stimulates fetal pancreatic insulin production. Later commitment, maternal glucose supply ceases even though newborn insulin production continues and results in hypoglycemia. Hypoglycemia may continue for 24–72 h until insulin secretion returns to normal.[14] Newborn glucose levels autumn to a low point in the first ane–2 h of life and so increased and stabilize gradually. It is clear that the IDM must be screened advisedly in the early hours of life for this possible complication.[15]

Loftier insulin, low glucagon, and epinephrine were observed in IDMs. As a consequence of this abnormal hormone profile, endogenous glucose product is significantly inhibited compared with that in normal infants, thus predisposing them to hypoglycemia.[16] Neonatal hypoglycemia is associated with poor neurological upshot. To ensure normal neural role in infants irrespective of the presence or absence of abnormal clinical signs, BG should be maintained within normal limit. Rapid diagnosis and prompt direction of patients with hypoglycemia is essential so that brain harm is to be avoided.[17].

The present study attempts to assess the BG levels in IDMs to observe frequency of hypoglycemia in IDMs and factors influencing it. The results of this study may augment our cognition with regard to BG assessment and its risk gene in IDMs.

MATERIALS AND ChiliadETHODS

A cross-sectional study was done in postnatal ward in Bangladesh Institute of Inquiry and Rehabilitation in Diabetic, Endocrine, and Metabolic Disorders (BIRDEM) from January to December 2009. BIRDEM is a tertiary care hospital, serves diabetic and other endocrine patients, so bulk neonates are IDMs. Approving from Upstanding Committee was obtained and written informed consent for the report was taken from all the patients. The data of IDMs were collected from postnatal ward. The infants were subjected to glucose estimation at predetermined intervals equally per protocol. All IDMs delivered during this flow staying in postnatal ward were included in this study. IDMs with very low birth weight (LBW), extremely LBW, birth asphyxia, respiratory distress, sepsis, built anomalies, and those admitted in special care baby unit (SCABU) after birth due to any other regions were excluded from this study.

IDMs is a term used to refer to infants born to mothers with either pre-GDM or GDM. For the study purpose hypoglycemia was divers as blood sugar <2.six mmol/l. Claret sugar was estimated by glucometer at 0, 2, 4, half-dozen, 8, 12, 18, and 24 h of life. All IDMs were fed by milk initially. Those developed hypoglycemia were managed past standard protocol. GDM has been defined every bit onset of glucose intolerance during pregnancy. Pre-GDM was defined as onset of glucose intolerance before pregnancy. According to WHO criteria, diagnosis of GDM was made if there was at least one (5.1, 10, and viii.5 mmol/l for fasting, 1-h, and 2-h plasma glucose concentration, respectively) abnormal value after a 75 yard oral glucose tolerance test.

Bed-side BG was measured past On-Phone call Plus BG meter, where whole BG concentration was measured through a quantitative amperometric analysis (glucose oxidase). The On-Call Plus BG monitoring organisation is an electrochemical enzymatic assay for the quantitative detection of glucose in capillary whole blood. It was one-impact ultrablood glucose monitoring system (K002134) similarities measurement that range from 20 to 600 mg/dl (1.1–33.3 mmol/l).

IDMs who adult hypoglycemia at any time during the first 24 h of age were included in hypoglycemic IDMs and who did non develop hypoglycemia during the commencement 24 h were included in normoglycemic IDMs. Mother of hypoglycemic IDMs was categorized into GDM and pre-GDM according to onset of DM.

Statistical Assay

The data analysis was performed with Epi Info vii software (Atlanta, Georgia). Statistical significance was set up at P < 0.05. The outcomes were compared between the hypoglycemic and normoglycemic IDMs and between GDM and pre-GDM in hypoglycemic group using Chi-square test and Fisher's verbal test.

RESULTS

In this study IDMs were 363, hypoglycemia adult in 139 (38.iii%) IDMs. There was no significant dissimilar maternal demographical characteristics between hypoglycemic and normoglycemic IDMs. In majority of cases, age of the mothers was between 21 and forty years and multigravidae. Maternal antenatal problems such as hypertension, pregnancy-induced hypertension (PIH), and preeclamptic toxemia (PET) and obstetrical complications such every bit abortion, intrauterine expiry (IUD), and neonatal death were equal in both normoglycemic and hypoglycemic group.

Duration of maternal diabetes was 1–216 (mean 27.1 ± 33.44) months in hypoglycemic group and 1–156 (mean 21.iii ± 27.83) months in normoglycemic group (P = 0.04). Control of maternal diabetes during pregnancy by diet were 33.viii and 66.ii% and by drug (Inj. insulin) in forty.ii and 59.8% in hypoglycemic and normoglycemic groups, respectively (P = 0.xi) [Table 1].

Table 1

Characteristics of mothers in relation to hypoglycemic and normoglycemic IDMs

Demographical characteristics of IDMs between hypoglycemic and normoglycemic group were non unlike significantly. Almost 96% babies were delivered past cesarean department, mean gestational age was about 36.5 weeks in each group, and male and female person ratio was 1:1. Nascency weight was 2792 ± 537.33 1000 in hypoglycemic group and 2906 ± 591.75 g in normoglycemic group; term babies were more preterm in both groups; and more than 86% baby's nascence weight was normal in both groups. Appropriate for gestational age (AGA) was more (79% vs 58.2%) in normoglycemic group, and hypoglycemia developed more than in large for gestational historic period (LGA) (28.1% vs 12.1%, P value = 0.0001) and statistically meaning [Table 2].

Tabular array 2

Characteristics of infants in relation to hypoglycemic and normoglycemic IDM

Types of maternal diabetes in hypoglycemic grouping were GDM in 43.two% and pre-GDM 56.8% cases. Hypoglycemia was more than in infants of multigravidae in pre-GDM group (82.2% vs 68.2%) and infants of primigravidae in GDM group (31.7% vs 17.7%) and statistically significant (P = 0.03). Maternal complications such equally HTN, PIH, and PET were observed in 8.three, 11.seven, and 1.7% in GDM and 10.1, iii.8, and 3.8% in pre-GDM, respectively, but P value was non meaning. Obstetrical complications such as ballgame (20% vs 24%), IUD (ten% vs vii.half-dozen%), and neonatal death (6.seven vs eleven.4%) were non statistically significant betwixt 2 groups.

Duration of maternal diabetes was i–12 (mean 3.23 ± ii.13) months in GDM and eleven–216 (mean 45.46 ± 34.65) months in pre-GDM, which was statistically significant (0.00001). Control of maternal diabetes during pregnancy with nutrition was more in GDM (53.3% vs 19%) and Inj. insulin was needed more in pre-GDM (81% vs 46.7%). P value was 0.001 [Table 3].

Table three

Characteristics of mothers in relation to type of maternal diabetes

About 96% babies were delivered past cesarean section in GDM and pre-GDM group. Male and female babies were equal in both groups. Gestational age was about 36.5 weeks in each group, mean birth weight was 3021.47 ± 568.04 in GDM grouping, and 2934.86 ± 513.30 in pre-GDM group. Hypoglycemia was significantly college in preterm in pre-GDM group (48.1% vs 28.3%) and in term in GDM group (71.7% vs 51.nine%) and statistically significant (P = 0.009). Hypoglycemia was more in normal birth weight than LBW in both groups. Hypoglycemia was observed in 76.vii% and 81% in AGA and 23.iii% and 18.9% in LGA in GDM group and pre-GDM group, respectively (P = 0.32) [Table 4].

Table 4

Characteristics of Infants in relation to type of maternal diabetes

Hypoglycemia developed within half dozen h of birth in 85.6% of IDMs (P-value = 0.00001). Hypoglycemia developed more at two h (92 cases), 4 h (59 cases), and 6 h (23 cases) than 0 h (nine cases), eight h (fourteen cases), 12 h (17 cases), 18 h (8 cases), and 24 h (5 cases) of historic period. Most of the IDM developed hypoglycemia at 2–half-dozen hours of age. Age of development of hypoglycemia were not much different between GDM and pre-GDM group [Table 5]. In this study, 56 (forty.three%) hypoglycemic IDMs were admitted in SCABU.

Table 5

Blood glucose in mmol/fifty in different group

DISCUSSION

Neonatal hypoglycemia occurs in IDMs with impaired gluconeogenesis, brought almost past excess insulin production, an inadequate substrate supply, decreased glucagon, and catecholamine secretion, which suggests altered counter-regulatory hormone product.[18,19,twenty]

Pedersen's hypothesis states that maternal hyperglycemia leads to fetal hyperglycemia, which leads to overstimulation of the islet cells of the fetal pancreas and to secondary fetal hyperinsulinism. And then the IDMs are at significant risk for the development of hypoglycemia.[21]

Of the 363 IDMs, hypoglycemia developed in 38.3% in this study and hypoglycemia was observed in 25–48% in dissimilar studies.[21,22,23]

Demographic characteristics of mother and IDMs were like in hypoglycemic and normoglycemic groups except duration of maternal diabetes (27.1 vs 21.3 months, P = 0.04) and LGA [(28.1% vs 12.1%, P value = 0.0001)], which were more than in hypoglycemic group. Hypoglycemic infants had significantly higher nascence weight and longer duration of DM, reported by Agarwal also.[23] Up to 50% of IDMs developed significant hypoglycemia subsequently nativity observed past Kicklighter. Hypoglycemia is more common in macrosomic IDMs than in IDMs who are of appropriate size for gestational age.[24] Neonatal hypoglycemia in the macrosomic IDM primarily is caused by a combination of hyperinsulinemia secondary to pancreatic islet cell hyperplasia and removal of the exogenous (maternal) glucose source at the fourth dimension of delivery. During pregnancy, elevated maternal serum glucose results in elevated fetal serum glucose because insulin does not cross the placenta.[24,25]

Near 43.ii% infants of GDM and 56.8% infants of pre-GDM adult hypoglycemia in our report. Carlow showed 15–25% of infants of GDM and 20–25% of infants of pre-GDM developed hypoglycemia. Hypoglycemia was more than in infants of pre-GDM, which was like to our study.[26] In mothers of pre-GDM, glycemic command were amend than mothers of GDM group, every bit they had experience to control diabetes.

Hypoglycemia was more in infants of multigravidae, which were more in pre-GDM than GDM and statistically pregnant (82.two% vs 68.3%, P value 0.03). Obstetrical complications such as abortion (61.3%), neonatal death (69.ii%), and maternal antenatal complications such equally HTN (61.five%) and PET (75%) were more in pre-GDM but not statistically meaning. Prolonged duration of diabetes in female parent (45.46 weeks vs three.23 weeks, P value = 0.00001) and control of diabetes in mother past Inj. insulin (81% vs 46.vii%, P = 0.001) was more than in pre-GDM and statistically meaning. Hypoglycemia was significantly college in term infants of GDM (71.7% vs 51.9%, P = 0.009) and in preterm infants of pre-GDM (48.one% vs 28.3%, P = 0.009) and statistically significant. This was our observation in this study.

In 85.6% IDMs developed hypoglycemia within vi h of nascence (P-value = 0.00001) and bulk (66.2%) were at two h of age. Agarwal found 47% infants adult hypoglycemia during the first 2 h of life in his study.^[23[ Later on birth plasma glucose fall in all infants, the nadir being reached in IDMs in first 1–4 hours of life and recovery may begin 4–6 hours, reported past Agrawal, Hawdon, and Robert.[23,27,28] Forty percentage hypoglycemic IDMs were admitted in SCABU in this written report. In IDMs when BG was <1.seven mmol/fifty in whatever fourth dimension and/or symptomatic, IDMs were admitted in SCABU and BG was 1.seven to <two.6 mmol/l after oral feeding patients were managed in postnatal ward. Serum glucose levels should exist checked and early initiation of feedings is highly recommended. Low BG levels during the first few hours of life tin can be prevented or treated with early and frequent oral feeding. In our study 46% hypoglycemic IDMs were admitted in SCABU. A large number of hypoglycemic IDMs were admitted because BG was <1.7 mmol/l within 24 h of life, symptomatic hypoglycemia and to ensure feeding with BG 1.vii to <2.6 mmol/fifty.

Neonatal hypoglycemia is associated with poor neurological outcome. Evidence suggests that BG should be maintained ≥2.6 mmol/fifty to ensure normal neural function in infants irrespective of the presence or absenteeism of abnormal clinical signs.[8]

What does study adds?

Regular monitoring of BG within first 24 h according to protocol in IDMs helps early recognition and appropriate intervention of hypoglycemia. A large number of IDMs developed hypoglycemia within 6 h in this study.

Limitation

The study population was selected from single-center and sample size was limited. Further study may exist undertaken from multiple centers with big sample size.

CONCLUSION

Hypoglycemia is a common problem in IDMs. A significant number of IDMs developed hypoglycemia in postnatal ward. Majority of IDMs developed hypoglycemia within vi h of historic period and almost of them were at 2 h of age. Duration of diabetes in mother and LGA babies were related to hypoglycemia in IDMs. Multigravidae, prolonged duration of maternal diabetes, preterm, and control of maternal diabetes with insulin were associated with hypoglycemia in infants of pre-GDM. To assure, early recognition and advisable intervention are needed in IDMs.

Financial back up and sponsorship

Zippo.

Conflicts of interest

There are no conflicts of involvement.

Acknowledgements

The author would like to thank all the participants who cooperated with this report.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166547/