Impact of metabolic control of diabetes during pregnancy on neonatal hypocalcemia: a randomized study.
OBJECTIVE
To test the hypothesis that strict control of diabetes during pregnancy can reduce the risk for neonatal hypocalcemia in infants of diabetic mothers.


METHODS
One hundred thirty-seven pregnant women with insulin-dependent diabetes enrolled before 9 weeks' gestation were randomized to one of two treatment groups. In 68 subjects, the goals were fasting blood glucose level less than 4.44 mmol/L (80 mg/dL) and 1.5-hour postprandial blood glucose level less than 6.66 mmol/L (120 mg/dL) (strict control), whereas in 69 the goals were fasting blood glucose level less than 5.55 mmol/L (100 mg/dL) and 1.5-hour post-prandial glucose level less than 7.77 mmol/L (140 mg/dL) (customary control).


RESULTS
Infants in the strict control group had a significantly lower rate of hypocalcemia (mean calcium less than 8.0 mg/dL in term infants and less than 7.0 mg/dL in preterm infants) than infants in the customary control group (17.6 versus 31.9%; P < .05). Using logistic regression analysis and after adjusting for the effects of gestational age, asphyxia, and White class on hypocalcemia, the difference between groups remained significant. The lowest infant serum calcium concentration correlated significantly with maternal glycohemoglobin A1 concentration at delivery (P = .03), gestational age (P = .0001), and the lowest serum magnesium concentration (P = .0001).


CONCLUSIONS
Strict management of diabetes in pregnancy is associated with a reduction in the rate of neonatal hypocalcemia.
Demarini
S
S
Perinatal Research Institute, University of Cincinnati College of Medicine, Ohio.
Mimouni
F
F
Tsang
R C
RC
Khoury
J
J
Hertzberg
V
V
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology / Q000517:prevention & control*; D007231:Infant, Newborn; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000628:therapy*; D012307:Risk Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin