A Retrospective Cohort Study in a University Hospital Evaluating the Effect of Maternal Glucose-Containing Intravenous Fluid in Neonatal Glycemia
Gelinemae G. Malaza, Elaine C. Cunanan
Apr 2019 DOI 10.35460/2546-1621.2018-0020 Access
Maternal hyperglycemia during the peripartum period is highly correlated with fetal hyperinsulinemia and consequent neonatal hypoglycemia. Liberal use of intravenous glucose therapy prior to delivery can potentially cause maternal hyperglycemia, therefore, it is prudent to implement all preventive measures.
This study aims to determine the occurrence of neonatal hypoglycemia with intravenous glucose therapy prior to delivery in maternal diabetes mellitus.
This was a retrospective cohort study of neonates born from diabetic mothers at the University of Santo Tomas Hospital Clinical and Private Divisions from January 1, 2013 to December 15, 2017. Clinical information gathered was divided into maternal and neonatal characteristics. Maternal intravenous fluid use, rate, and duration were noted; maternal and neonatal blood glucose results were obtained.
There were 109 infants of diabetic mothers, of which 105 were delivered as singleton and 4 from twin pregnancies. Neonatal hypoglycemia was present in 14.68%. Comparing the risk factors, there was a higher amount of glucose infused to the mothers whose offspring developed hypoglycemia compared to those without hypoglycemia. Statistically, this did not demonstrate a significant difference. The rate of glucose infusion and frequency of maternal insulin use were similar between the groups. Linear correlation was not evident when the total glucose infused and the rate of intravenous glucose infusion was compared to the neonatal glucose in the first hour of life.
Based on this study, routine administration of glucose-containing intravenous fluid did not influence the incidence of neonatal hypoglycemia. It is recommended that further prospective studies be conducted.
Keywords: gestational diabetes mellitus, neonatal hypoglycemia, intravenous fluid
- Alemu B, Baydoun H, Olayinka O, et al. Neonatal hypoglycemia in diabetic mothers: A systematic review. Current Pediatric Research. 2017;21(1):42–53.
- Behrman RE, Kliegman R, Jenson HB. Nelson Textbook of Pediatrics. Philadelphia:W.B. Saunders Co.; 2000.
- Dawood F, Dowswell T, Quenby S. Intravenous fluids for reducing the duration of labour in low risk nulliparous women. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD007715. DOI: 10.1002/14651858.CD007715.pub2
- Kalra P, Anakal M. Peripartum management of diabetes. Indian Journal of Endocrinology and Metabolism. 2013;17(7):72.
- Metzger B, Persson B, Lowe L, et al. Hyperglycemia and Adverse Pregnancy Outcome Study: Neonatal Glycemia. Pediatrics. 2010 Dec;126:6.
- Knip M, Lautala P, Leppäluoto J, et al. Relation of enteroinsular hormones at birth to macrosomia and neonatal hypoglycemia in infants of diabetic mothers. Journal of Pediatrics. 1983 Oct;103(4):603–11.
- Grylack L, Chu S, Scanlon J. Use of intravenous fluids before cesarian section: effects on perinatal glucose, insulin, and sodium homeostasis. Obstetrics & Gynecology. 1984;63(5):654–8.
- Carmen S. Neonatal hypoglycemia in response to maternal glucose infusion before delivery. Journal of Obstetric, Gynecologic & Neonatal Nursing. 1986;15(4):319–23.
- Rosenberg VA, Eglinton GS, Rauch ER, et al. Intrapartum maternal glycemic control in women with insulin requiring diabetes: A randomized clinical trial of rotating fluids versus insulin drip. American Journal of Obstetric and Gynecology. 2006;195:1095–9.
- Diabetes in pregnancy: management from preconception to the postnatal period [Internet]. [cited 2019 Apr 3]. Available from: https://www.nice.org.uk/guidance/ng3/resources/diabetes-in-pregnancy-management-from-preconception-to-the-postnatal-period-51038446021
- Iafusco D, Stoppoloni F, Salvia G, et al. Use of real time continuous glucose monitoring and intravenous insulin in type 1 diabetic mothers to prevent respiratory distress and hypoglycaemia in infants. BMC Pregnancy & Childbirth. 2008;8:23.
- American Diabetes Association Standards of Medical Care in Diabetes – 2017. Diabetes Care. 2017;40(1):S1–S135.
- Sirimarco M, Guerra H, Lisboa E, Vernini J, et. al. Diagnostic protocol for gestational diabetes mellitus (GDM) (IADPSG/ADA, 2011): influence on the occurrence of GDM and mild gestational hyperglycemia (MGH) and on the perinatal outcomes. Diabetology & Metabolic Syndrome [Internet]. 2017. Available from: https://dmsjournal.biomedcentral.com/track/pdf/10.1186/s13098-016-0200-2?site=dmsjournal.biomedcentral.com
- Mayaan-Metzger A, Lubin D, Kuint J. Hypoglycemia rate in the first days of life among term infants born to diabetic mothers. Neonatology. 2009;96:80–85.
- Mendiola J, Grylack LJ, Scanlon JW. Effects of intrapartum maternal glucose infusion on the normal fetus and newborn. Anesthesia & Analgesia. 1982;61:32–5.
- Iwasaku K, Tosaki M, Higashi Y, et al. Effect of glucose-containing intravenous fluid administered before cesarian section on maternal and neonatal blood glucose levels. Advances in Obstetrics and Gynecology. 1992;44(4):351–6.
- Milner R, Hales C. Effect of intravenous glucose on concentration of insulin in maternal and umbilical-cord plasma. British Medical Journal. 1965:1:284–6.
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