Rate and risk factors of hypoglycemia in large-for-gestational-age newborn infants of nondiabetic mothers.
OBJECTIVE
The purpose of this study was to investigate the rate of hypoglycemia in large-for-gestational-age infants of nondiabetic mothers in relation to maternal or neonatal risk factors.


METHODS
Hospital charts of all term large-for-gestational-age infants born between 1994 and 1998 (n = 1136) were analyzed for the rate of neonatal hypoglycemia (capillary glucose level, < or =30 mg/dL) during the first 24 hours of life. Infants of women with preexisting or gestational diabetes mellitus were excluded (n = 180). Neonatal glucose testing was performed at 1 or 2 hours of life, with subsequent measurements every 4 to 6 hours. Maternal and neonatal parameters were compared between neonates with and without hypoglycemia, including recent oral glucose tolerance test values in those women who were tested (n = 358).


RESULTS
Of 956 infants, 69 infants (7.2%) were not tested for hypoglycemia. In the remaining 887 infants, hypoglycemia occurred in 142 infants (16%) within the first 24 hours of life. The incidence of hypoglycemia decreased sharply during the first few hours of life, from 9.2% within the first hour of life, to 3.5% between 2 to 5 hours (cumulative) of life, and 2.4% between 6 and 24 hours of life. Gestational age at delivery was the only neonatal parameter that differed significantly between infants with and without hypoglycemia (39.5 vs 39.3 weeks, P =.01). The antenatal 1-hour oral glucose tolerance test value was the only predictive maternal parameter (141.5 vs 163.0 mg/dL, P <.006). There was an incremental risk of hypoglycemia with increasing 1-hour oral glucose tolerance test values, with hypoglycemia rates of 2.5%, 9.3%, 22.0%, and 50.0% that were associated with maternal 1-hour glucose values of <120, 120-179, 180-239, and > or =240 mg/dL, respectively (P <.05, for all comparisons).


CONCLUSIONS
Routine glucose testing is indicated in large-for-gestational-age newborn infants of nondiabetic mothers. The 1-hour glucose value of the maternal oral glucose tolerance test is a fairly good predictor of subsequent neonatal hypoglycemia. A single elevated 1-hour value of > or =180 mg/dL markedly increases the risk of neonatal hypoglycemia.
Schaefer-Graf
Ute M
UM
Department of Obstetrics, Vivantes Medical Center Neukoelln, Charité, Campus Virchow-Klinikum, Humboldt-University, Berlin, Germany.
Rossi
Rainer
R
Bührer
Christoph
C
Siebert
Gerda
G
Kjos
Siri L
SL
Dudenhausen
Joachim W
JW
Vetter
Klaus
K
D000328:Adult; D000375:Aging / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications*; D005865:Gestational Age; D005951:Glucose Tolerance Test; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D015994:Incidence; D007231:Infant, Newborn; D036801:Parturition; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors
D001786:Blood Glucose