title: The duration of intrapartum maternal hyperglycaemia predicts neonatal hypoglycaemia in women with pre-existing diabetes.
abstract: There is a high incidence of neonatal hypoglycaemia in neonates born to mothers with pre-existing diabetes. This often necessitates admission to the neonatal intensive care. Guidelines suggest maintaining intrapartum blood glucose levels (BGLs) of 4-7 mmol/l in women with diabetes to reduce the risk of neonatal hypoglycaemia. This study assessed whether intrapartum BGLs in women with pre-gestational Type 1 and 2 diabetes were predictive of neonatal hypoglycaemia.
  
  
  
  A retrospective analysis of 261 births delivered at a tertiary hospital in Australia from 2009 to 2014.
  
  
  
  There were 122 cases of neonatal hypoglycaemia (glucose ≤ 2.6 mmol/l) in 261 births (47%). The mothers in the neonatal hypoglycaemia group spent less time with BGL in the range 4-7 mmol/l [55 ± 37% vs. 65 ± 35%, P = 0.02; odds ratio (OR) 0.992, P = 0.03] and more time with BGL in the 7-10 mmol/l range (31 ± 34% vs. 18 ± 27%, P = 0.003; OR 1.013, P = 0.003) compared with those without neonatal hypoglycaemia. Although statistically significant, receiver operating characteristic (ROC) curve analysis showed that time spent with maternal BGLs in the range 4-7 mmol/l [area under the curve (AUC) = 0.58] or 7-10 mmol (AUC = 0.60) was not strong enough to be a useful clinical predictor of neonatal hypoglycaemia. HbA1cin the second trimester of pregnancy (P = 0.02, OR 1.42) and percentage time spent in BGL range of 7-10 mmol/l (P = 0.001, OR 1.02) were both associated with a risk of neonatal hypoglycaemia in a logistic regression model. HbA1cin the third trimester (P = 0.07, OR 1.28) approached, but did not reach, significance.
  
  
  
  These data support a BGL range of 4-7 mmol/l as an intrapartum target. Glycaemic control in the second trimester is associated with neonatal hypoglycaemia. Improvement in ante- and intrapartum glycaemic control may reduce neonatal hypoglycaemia in women with pre-existing diabetes.
authors.affiliation: Department of Diabetes, John Hunter Hospital, Newcastle, NSW, Australia.|Department of Medicine, John Hunter Hospital, Newcastle, NSW, Australia.|Faculty of Medicine and Health, University of Newcastle, Newcastle, NSW, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Joshi
authors.affiliation: Faculty of Medicine and Health, University of Newcastle, Newcastle, NSW, Australia.|Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Oldmeadow
authors.affiliation: Department of Medicine, John Hunter Hospital, Newcastle, NSW, Australia.|Faculty of Medicine and Health, University of Newcastle, Newcastle, NSW, Australia.|Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Attia
authors.affiliation: Department of Diabetes, John Hunter Hospital, Newcastle, NSW, Australia.|Department of Medicine, John Hunter Hospital, Newcastle, NSW, Australia.|Faculty of Medicine and Health, University of Newcastle, Newcastle, NSW, Australia.|Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Wynne
mesh_terms: D000328:Adult; D001315:Australia; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D007003:Hypoglycemia / Q000097:blood / Q000151:congenital* / Q000175:diagnosis*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000097:blood / Q000175:diagnosis*; D036801:Parturition / Q000097:blood*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000175:diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose