A prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes mellitus

Roux, Juana A. Flores‐Le; Sagarra, Enric Ballesteros i; Benaiges, David; Hernandez-Rivas, Elisa; Chillarón, Juan J.; Dou, Jaume Puig de; Mur, Antonio; López-Vílchez, María Ángeles; Pedro‐Botet, Juan

doi:10.1016/j.diabres.2012.03.011

Cited by 46 publications

(44 citation statements)

References 27 publications

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“…The following classification of neonatal HG was applied: capillary blood glucose (CBG) values were considered normal when ≥ 2.5 mmol/l, or HG was mild (2.2-2.4 mmol/l), moderate (1.6-2.1 mmol/l) or severe HG (<1.6 mmol/l) (7).…”

Section: Methodsmentioning

confidence: 99%

Neonatal Hypoglycemia: Risk Factors and Outcomes

Stomnaroska

Petkovska

Jancevska

et al. 2017

Prilozi

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background and aims:Severe neonatal hypoglycemia (HG) leads to neurologic damage, mental retardation, epilepsy, personality disorders, impaired cardiac performance and muscle weakness. We aimed to assess the clinical characteristics of children with hypoglycemia in a random population of newborns. Patients, methods and results: We investigated 84 patients (M:F=35:48) born at the University Clinic for Gynecology and Obstetrics in Skopje (hospitalized in the NICU) who were found to have hypoglycemia. In total 89.25% of the babies were premature. The mean birth weight was 1795.95 +/596.08 grams, the mean birth length was 41.92+/-4.62 cm, while the mean gestational age was 33.05±3.19 weeks. 32 children (38.08%) were very low birth weight (<1500g), 38 (45.22%) were low birth weight (1500-2500g), while there were 8 children (9.52%) appropriate for age BW and no high BW for age patients (>4000 g). HG duration was 2.42+/-2.41 hours. In the group as a whole, hypoxic-ischemic encephalopathy (HIE) was found in 3 children (3.57%), infections in 22 (26.18%), respiratory distress syndrome (RDS) in 9 patients (10.62%), intracranial haemorrhage in 2 patients (2.38%). There were no inborn errors of metabolism. There were two deaths (2.38%). conclusion: Neonatal HG is a significant factor in the overall neonatal mortality. HG can also cause severe invalidity. We found that infections, LBW and low gestational age were most commonly associated with neonatal HG. However the Spearman test showed weak direct correlation, without statistical significance. Neonatal HG requires complex and team interaction of prenatal and postnatal approaches to reduce the incidence of seizures, their consequences and the overall mortality. Special consideration is to be taken in measures that avoid neonatal infections, HIE, LBW and low gestational age. Further studies on a larger population are needed to fully understand and prevent the phenomenon of HG in newborns.

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Section: Methodsmentioning

confidence: 99%

Neonatal Hypoglycemia: Risk Factors and Outcomes

Stomnaroska

Petkovska

Jancevska

et al. 2017

Prilozi

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“…É espectável que tal ocorra entre a primeira e a quarta hora de vida. 22,25,32,35,38,40 As hormonas da contrarregulação -glucagon e catecolaminas -são transitoriamente insuficientes para a mobilização do glicogénio e para ativação da gluconeogénese. 4,22,27,32,38 Em regra, o bom controlo metabólico associa-se a uma diminuição da ocorrência de hipoglicemia e seria previsível que tal acontecesse sobretudo nos recém--nascidos GIG e LIG, 22 o que não se verificou nesta série.…”

Section: 39unclassified

Diabetes gestacional - Otimização do controlo materno e morbilidade neonatal

Mimoso

2018

Acta Pediátrica Port

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Introduction: Gestational diabetes has one of the highest rates of perinatal and obstetric complications of any disease. Early diagnosis and rigorous metabolic control are essential to reduce perinatal morbidity. Maternal hyperglycaemia causes fetal hyperglycaemia and hyperinsulinism and is responsible for most fetal complications, including prematurity, macrosomia, neonatal hypoglycaemia and hyperbilirubinaemia. We assessed the evolution of neonatal morbidity in babies of women with gestational diabetes in the current pregnancy, seeking possible correlations between neonatal morbidity and maternal metabolic control. Methods:The study included all babies born in a level III maternity hospital whose mothers, followed at the same institution between 1994 and 2013, had single--fetus pregnancy complicated by diabetes. A perinatal database was used and morbidity and perinatal mortality were analysed over three periods, according to the diagnostic and therapeutic protocol in use.Results: There were 2440 women who met the inclusion criteria. Over the study period, gestational diabetes was diagnosed earlier, insulin therapy was used more frequently, there were fewer macrosomic newborns, and morbidity associated with gestational diabetes decreased. However, in the last three years the number of smaller for gestational age newborns, neonatal hypoglycaemia, and congenital anomalies all increased. Discussion: Our analysis enabled us to characterise the main steps in the follow-up of women with gestational diabetes. In the last three years of the study period (2011)(2012)(2013), an increase in neonatal morbidity was observed, which needs to be explained and monitored.Keywords: Diabetes, Gestational; Diabetes Mellitus, Infant, Newborn, Diseases; Neonatal; Morbidity; Pregnancy Complications Introdução: A diabetes gestacional é uma das complicações médicas mais frequentes na gravidez. O diagnóstico mais precoce e o rigor do controlo metabólico são fundamentais para diminuir a morbilidade perinatal. A hiperglicemia materna ao induzir hiperglicemia fetal e consequente hiperinsulinismo, é responsável pela maioria das complicações do feto e no recém-nascido. Pretendeu-se avaliar a evolução da morbilidade neonatal de filhos de mães com diabetes gestacional explorando as possíveis correlações entre a morbilidade neonatal e o controlo metabólico materno. Métodos: Estudo observacional analítico, retrospetivo descritivo de recém-nascidos de mães com diabetes gestacional com gravidez unifetal seguidas numa maternidade de nível III no período de 1994 e 2013, com recurso à informação clínica de ambos, recolhida de um modo longitudinal sistemático e armazenada em base de dados. Analisou-se a evolução da morbilidade e mortalidade perinatal em três períodos, agrupados de acordo com o protocolo de diagnóstico e de terapêutica utilizado. Resultados: Analisaram-se 2440 díades mãe-filho. Nestes 20 anos o diagnóstico de diabetes gestacional foi mais precoce, a administração de insulinoterapia mais frequente o que condicionou menor número d...

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“…Apesar da determinação da glicémia capilar ser menos fiável, sobretudo em situações de hematócrito elevado e glicémia mais baixa, no RN é frequente a sua utilização já que necessita de quantidades reduzidas de sangue e permite o diagnósti-co e intervenção. 37 Na literatura a hipoglicémia no FMD associa-se à obesidade materna, a acidose ao nascer, a ser LIG e à mãe ter necessitado de insulina durante a gravidez e/ou ter tido hiperglicémia durante o trabalho de parto. 38 Neste trabalho, associou-se sobretudo com a precocidade do diagnóstico e com a morbilidade associada (HTA).…”

Section: 33unclassified

Morbilidade Neonatal na Diabetes Gestacional: Coincidência ou Consequência do Consenso de 2011

Mimoso

Oliveira

2017

Acta Med Port

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Gestational diabetes is one of the diseases associated with pregnancy with higher rate of complications. Despite being a transitory condition, short and long term complications related to gestational diabetes have been described. There is scientific evidence to say that good metabolic control decreases perinatal complications. In 2011, new criteria was proposed for its diagnosis, which made possible its diagnosis during the 1 st trimester of pregnancy. The aim of this study is to compare neonatal morbidity in two groups of women with gestational diabetes diagnosis before and after the latest Portuguese guidelines for diabetes and pregnancy were published (February 2011). Material and Methods:We included all newborns born in Maternidade Bissaya Barreto whose mother, followed at our maternity between 2008 and 2013, had unifetal pregnancy complicated by diabetes. We used a perinatal database and analysed the impact of the new guidelines in perinatal morbidity over two periods of three years. Results: There were 774 women who met the inclusion criteria. We found that gestational diabetes was diagnosed earlier, insulin therapy was more frequent. Neonatal morbidity was increased, and there were more cases of neonatal hypoglycemia and congenital anomalies, and newborns became smaller for gestational age. Discussion: The increase in neonatal morbidity was associated with early diagnosis and rigorous metabolic control. Conclusion: To analyse national data will be fundamental to understand this unexpected increase in morbidity. Keywords: Diabetes, Gestational; Infant, Newborn, Diseases; Pregnancy Complications INTRODUÇÃOA diabetes gestacional (DG) é uma intolerância à glicose que se desencadeia com a gravidez, de gravidade variável, podendo apresentar-se desde formas ligeiras de intolerância até à diabetes prévia à gravidez, ainda não identificada. 1-3A DG é atualmente diagnosticada pela determinação da glicémia em jejum em consulta pré-natal. Se este valor for normal realiza-se a prova de tolerância à glicose oral (PTGO) com a administração de 75 g de glicose entre as 24 e as 28 semanas de gestação. A maioria dos casos (70% a 85%) de DG é adequadamente tratada com dieta e exercício físico, contudo, algumas grávidas necessitam de terapêutica com insulina. 3-8O rastreio universal de DG vigora em Portugal 9 sendo sustentado pelo facto de 30% a 50% das mulheres não apresentarem fatores de risco para esta condição. 8,10,11 Esta forma de diagnosticar a DG é suportada por estudos clínicos que, como o Hyperglycemia and Adverse Pregnancy Outcomes (HAPO), 12 demonstraram uma associação linear positiva entre o valor da glicémia e as complicações da gravidez em mulheres sem DG. 2,5,6,9,[11][12][13][14][15] A DG é considerada uma das complicações da gravidez

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A prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes mellitus

Cited by 46 publications

References 27 publications

Neonatal Hypoglycemia: Risk Factors and Outcomes

Neonatal Hypoglycemia: Risk Factors and Outcomes

Diabetes gestacional - Otimização do controlo materno e morbilidade neonatal

Morbilidade Neonatal na Diabetes Gestacional: Coincidência ou Consequência do Consenso de 2011

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