Risk factors and outcomes for neonatal hypoglycaemia and neonatal hyperbilirubinaemia in pregnancies complicated by gestational diabetes mellitus: a single centre retrospective 3‐year review

Abstract

Aim To determine risk factors associated with neonatal hypoglycaemia and hyperbilirubinaemia, and assess their impact on neonatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). Methods Retrospective review investigating all pregnancies complicated by GDM at Campbelltown Hospital (Sydney, Australia) between 1 January 2013 and 31 December 2015. Main outcomes measured were neonatal hypoglycaemia (capillary glucose levels < 1.8 mmol/l) and hyperbilirubinaemia (total serum bilirubin levels greater than age‐appropriate thresholds for phototherapy). Adjusted odds ratios [95% confidence interval (CI)] are shown, calculated by multivariable logistic regression. Results Some 60 (7.8%) infants developed hypoglycaemia, 58 (7.5%) developed hyperbilirubinaemia and 13 (1.7%) developed both. Risk of developing hypoglycaemia increased 1.8‐fold (95% CI 1.3–2.6, P < 0.001) per gestational week at GDM diagnosis, 1.1‐fold (95% CI 1.0–1.3, P = 0.04) per mmol/l maternal fasting glucose, 6.2‐fold (95% CI 2.6–16.2, P < 0.001) with maternal history of macrosomia, 10.8‐fold (95% CI 4.1–27.6, P < 0.001) with multiple pregnancy and 1.1‐fold (95% CI 1.0–1.3, P = 0.04) per gestational week at birth. Risk of hyperbilirubinaemia increased with multiple pregnancy (26.4; 95% CI 11.7–59.7, P < 0.001), and 1.5‐fold (95% CI 1.1–2.1, P = 0.01) per gestational week at GDM diagnosis. Hypoglycaemia was associated with a 2.8‐fold (95% CI 1.1–7.1, P = 0.03) increased risk of macrosomia, a 5.4‐fold (95% CI 1.1–27.3, P = 0.04) excess risk of shoulder dystocia and a 6.4‐fold increased risk of 5‐min APGAR ≤ 7 (95% CI 1.2–1.7, P < 0.001). Hyperbilirubinaemia was associated with an excess risk of polycythaemia (packed cell volume > 0.6; 97.1, 95% CI 38.9–241.5, P < 0.001). Conclusions Neonatal hypoglycaemia and hyperbilirubinaemia largely occur in different pregnancies. Both are associated with earlier GDM diagnosis; however, hypoglycaemia is more associated with maternal glycaemia and its sequelae, and hyperbilirubinaemia is associated with polycythaemia.

Markers of glycation and neonatal hypoglycaemia in gestational diabetes mellitus

“…Late GDM was diagnosed as at least one abnormal result of a 75‐g oral glucose tolerance test at 24–28 weeks of amenorrhea (blood glucose ≥ 0.92 g/l at time T0, ≥ 1.80 g/l at 60 min or ≥ 1.53 g/l at 120 min) and early GDM was diagnosed as fasting blood glucose at the first trimester of between 0.92 and 1.26 g/l, according to the guidelines of the French Speaking Diabetes Society. We systematically registered neonatal hypoglycaemia in 197 newborns of these women: 17 (8.6%) newborns experienced hypoglycaemia, a rate quite similar to that reported by Thevarajah and Simmons . Comparison between the mothers of children with hypoglycaemia and those without hypoglycaemia is given in Table .…”

“…We were interested in the article by Thevarajah and Simmons, who analysed the risk factors for neonatal hypoglycaemia in 767 women with gestational diabetes mellitus (GDM) . Neonatal hypoglycaemia was associated with a lower gestational age at diagnosis of GDM, and Thevarajah and Simmons suggest that this may be explained by intrauterine epigenetic modifications driven by early hyperglycaemia, a mechanism potentially related to glucose memory.…”

Association between neonatal hyperbilirubinemia and hypoglycemia in Chinese women with diabetes in pregnancy and influence factors

“…As the fetus is in the uterus with hyperglycemia, the physiological and pathological mechanisms of NH and NHB may be correlated, which has rarely been studied. Research evidence shows that there is no correlation was found between NH and NHB in pregnant women with GDM, which may be related to the small sample size 11 . Based on the physiological mechanism, this study attempted to increase the sample size and collect more comprehensive variables in Chinese diabetic pregnant women to understand the relationship between NH and NHB.…”

Metformin: A promising option for the management of gestational diabetes mellitus – Exploring the benefits, challenges and clinical needs in the current management of gestational diabetes mellitus

“…A trial in Belgium identified that insulin‐treated GDM women still had large babies and more CS even after adjusting for BMI, GWG and age compared to diet‐managed women 10 . It is purported by the Pedersen hypothesis that maternal hyperglycaemia leads to fetal hyperinsulinaemia and neonatal hypoglycaemia 12 ; however, whether exogenous insulin therapy improves these outcomes, specifically, neonatal hypoglycaemia, remains disputable. Research in women treated with insulin in pregnancy still shows higher rates of neonatal hypoglycaemia requiring intravenous glucose treatment and neonatal nursery admission 6,8 .…”