Abstract
This study aimed to investigate the risk factors associated with neonatal hypoglycemia and its correlation with blood glucose control in patients with gestational diabetes mellitus (GDM). This study was a retrospective study. 880 pregnant women with GDM and their newborns were hospitalized from January 2018 to December 2022 in our hospital. The clinical information of GDM pregnant women and their newborns were reviewed and the hemoglobin A1c (HbA1c) values measured within 1 week before delivery were collected. According to the occurrence of neonatal hypoglycemia, which was divided into the control and observation groups. Logistic regression model was used to estimate the potential factors associated with neonatal hypoglycemia. The association between HbA1c of pregnant women before delivery and abnormal glucose metabolism in newborns was examined using spearman correlation analysis. A total of 104 cases of hypoglycemia occurred in neonates delivered by 880 GDM women and the incidence of neonatal hypoglycemia was 11.82%. There were significant differences in pre-pregnancy overweight or obesity, delivery mode, maternal blood sugar control effect and neonatal feeding standard between the 2 groups of GDM women (P < .05). Pre-pregnancy overweight or obesity, poor blood sugar control in GDM women, and improper neonatal feeding were risk factors for neonatal hypoglycemia. The results of logistic regression analysis showed that abnormal glucose metabolism in newborn (odds ratio [OR]: 2.43, 95% confidence interval [CI]: 1.12–4.73) and neonatal hypoglycemia (OR: 3.04, 95% CI: 1.33–5.79) were a risk factor. We also conducted the logistic analysis to evaluate the correlation between HbA1c before delivery and abnormal glucose metabolism in newborns of pregnant women with GDM through adjusting some potential factors. The results were still significant in the abnormal glucose metabolism in newborn (OR: 2.84, 95% CI: 1.23–6.63) and neonatal hypoglycemia (OR: 3.64, 95% CI: 1.46–8.18). Overweight or obesity of GDM parturient before pregnancy, poor blood glucose control of GDM parturient and improper feeding of newborns are all risk factors for neonatal hypoglycemia. HbA1c before delivery has a certain predictive value for abnormal glucose metabolism in newborns.
Keywords: blood glucose control, gestational diabetes mellitus, hypoglycemia, newborn, risk factors
1. Introduction
Neonatal hypoglycemia is the most prevalent metabolic disorder among newborns, with an incidence rate ranging from 5% to 15%, and reaching as high as 50% in high-risk neonates.[1] Research indicates that neonatal hypoglycemia constitutes a significant risk factor for learning disabilities, attention deficits, developmental delays, hyperactivity, epilepsy, and autism spectrum disorders.[2] Early manifestations of neonatal hypoglycemia may be asymptomatic or present as mild diaphoresis, lethargy, feeding difficulties, and decreased responsiveness, often lacking typical symptoms, thereby posing challenges for timely clinical detection.[3] Given that the energy supply to the neonatal brain primarily relies on glucose, persistent or recurrent episodes of hypoglycemia can profoundly disrupt neurological development, with severe cases even posing life-threatening risks.[4] Consequently, effective prevention and management of neonatal hypoglycemia hold paramount importance in ensuring healthy developmental outcomes for newborns.
The occurrence of abnormal blood glucose in newborns is related to many factors, among which abnormal glucose metabolism during pregnancy is one of the main risk factors that cannot be ignored.[5,6] Gestational diabetes mellitus (GDM) is among the most common complications experienced by expectant mothers during pregnancy. Currently, its incidence is on the rise, leading to various adverse effects such as fetal malformation, intrauterine distress, polyhydramnios, and gestational hypertension, with potential life-threatening consequences for both the mother and the fetus.[7] In the case of pregnant women with gestational diabetes, prolonged exposure to hyperglycemia not only affects the mother’s blood glucose levels but also exposes the fetus to a similar state of elevated blood glucose. This leads to compensatory enhancement of pancreatic islet cell function in the fetus, resulting in increased insulin levels. However, after umbilical cord clamping, when the maternal supply of glucose ceases, premature infants continue to secrete insulin at higher levels, causing excessive reduction in blood sugar levels and subsequently leading to hypoglycemia.[8,9] Research has indicated that well-controlled blood glucose levels in pregnant women with gestational diabetes significantly improve the aforementioned adverse outcomes for both mother and baby.[10] Therefore, prioritizing optimal blood glucose control in GDM patients becomes paramount.
At present, the blood glucose control of pregnant women with GDM is mainly based on diet control and exercise and other non-drug intervention, adding hypoglycemic drugs and insulin therapy to those with poor blood glucose control.[11] The guidelines of the American Diabetes Association in 2020 recommend that pregnant women with GDM regularly monitor their blood glucose. It is recommended that the blood glucose level should be controlled to fasting blood glucose < 5.3 mmol/L, 1-hour postprandial blood glucose < 7.8 mmol/L or 2 hours postprandial blood glucose < 6.7 mmol/L. Among the existing blood glucose monitoring standards, we mainly rely on pregnant women’s self-monitoring of blood glucose and continuous blood glucose monitoring (CGM) to obtain more accurate blood glucose control. Self-monitoring of blood glucose fingertip blood glucose only reflects the transient state. This method needs to measure fingertip blood glucose values (fasting, pre-meal and postprandial) several times a day, so the compliance of pregnant women is low. CGM can obtain the blood glucose spectrum of GDM patients by using subcutaneous sensor to measure the concentration of glucose in inter-tissue fluid, which can clearly show the blood glucose condition and blood glucose fluctuation of pregnant women with GDM. However, the high price of CGM and the invasive blood glucose monitoring method make it difficult to be widely used in GDM population.
Maternal-derived glucose metabolism indicators, such as glycosylated hemoglobin, can reflect the blood sugar control of pregnant women in the past period. It can also indirectly reflect the cumulative blood glucose exposure level of the fetus in utero. Glycosylated hemoglobin is the product of a slow, continuous and irreversible non-enzymatic reaction between hemoglobin in red blood cells and glucose in plasma. Hemoglobin A1c (HbA1c) is stable in structure, so HbA1c is often used as a monitoring indicator for blood sugar levels in diabetic patients. The level of HbA1c depends mainly on the plasma glucose level, which is proportional to the plasma glucose concentration and the duration of high plasma glucose concentration. Since the replacement time of red blood cells is about 120 days, HbA1c can reflect the previous blood glucose control level from 2 to 3 months. HbA1c is not affected by temporary blood glucose fluctuations and does not need to be detected under fasting, which is more reproducible and more convenient. Therefore, HbA1c is common indicators to reflect the blood glucose control level of pregnant women with GDM. Based on this, this paper took 220 pregnant women with GDM and their newborns to analyze the risk factors of neonatal hypoglycemia and the correlation between hypoglycemia and GDM blood glucose control.
2. Materials and methods
2.1. General information
Eight hundred and eighty pregnant women with GDM and their newborns were hospitalized from January 2018 to December 2022 in our hospital. The clinical information of GDM pregnant women and their newborns were reviewed and the serum HbA1c level measured within 1 week before delivery were collected. According to the occurrence of neonatal hypoglycemia, the neonates were divided into 2 groups: the control group (n = 776) and the observation group (n = 104). The study protocol was approved by the Ethics Committee of Wuhan Children’s Hospital.
Inclusion criteria: a definite diagnosis of gestational diabetes mellitus, the diagnostic criteria refer to the guidelines for the diagnosis and treatment of gestational diabetes mellitus formulated by the Obstetrics and Gynecology Branch of the Chinese Medical Association (2014)[10]; fasting blood glucose ≥ 5.8 mmol/L was measured twice or more; glucose tolerance test: oral glucose 75 g after fasting for 12 hours and record blood glucose values at 4 points, including fasting and 1, 2, and 3 hours after taking glucose, of which ≥ 2 time points exceed the normal value; and all were singletons pregnancy and successful delivery.
Exclusion criteria: multiple births; incomplete clinical data; and malignant tumors and a history of diabetes.
2.2. Methods
By consulting the electronic medical record system, the HbA1c level examined by pregnant women in the obstetrics or inpatient department within 3 months before delivery was recorded as an indicator of long-term and short-term blood glucose exposure. In this study, newborns born to pregnant women with GDM should start breastfeeding and measure blood sugar as soon as possible after birth. The initial blood glucose value of a newborn is defined as the peripheral blood glucose value measured by medical staff using the same blood glucose meter before breastfeeding after birth. Neonatal blood glucose value and abnormal blood glucose are affected by many factors. At the same time, the data of maternal age, parity, pregnancy cycle, delivery mode, blood glucose control during pregnancy, premature delivery, neonatal sex, weight, body temperature and feeding norms were recorded. Demographic characteristics and possible confounding factors such as pregnancy complications, gestational age, birth weight, incidence of neonatal acute respiratory distress syndrome, Apgar score, amniotic fluid, placental abnormality, prenatal application of hormones to promote fetal lung maturation.
Relevant diagnostic criteria of pre-pregnancy overweight or obesity criteria:[12] According to the body mass index (BMI), BMI ≥ 24.0 to 28.0 kg/m2 is overweight and BMI ≥ 28.0 kg/m2 is obese. Good standard of blood sugar control for pregnant women in GDM: 3.3 mmol/L < fasting blood glucose < 5.6 mmol/L, 4.4 mmol/L < 2 hour postprandial blood glucose < 6.7 mmol/L. Low birth weight standard was birth weight < 2500 g.[13] The standard of neonatal hypothermia was rectal temperature ≤ 35°C, cold body surface and low reaction. For those with blood sugar < 3.3 mmol/L, breastfeed on demand for 0.5 hour postpartum, 15 to 20 mL of 10% glucose solution within 2 hours postpartum and 20 mL of formula milk for 2 to 6 hours postpartum.
2.3. Statistical analysis
SPSS 25.0 software was used to process all data. Measurement data were tested for normal distribution and homogeneity of variance before statistical analysis to meet the requirements of normal distribution or approximately normal distribution, expressed as means ± standard deviation and compared using t test. Count data was expressed as n (%). Logistic regression analysis was used to analyze the influencing factors of neonatal hypoglycemia. Pearson correlation was used to analyze the binary correlation between HbA1c of pregnant women before delivery and initial blood glucose value of newborns in GDM. P < .05 indicated that the difference was statistically significant.
3. Results
3.1. Participants demographics characteristics
We analyzed the general situation of parturient and newborns of GDM in the group. There were 104 cases of neonatal hypoglycemia delivered by GDM parturient, and the incidence of neonatal hypoglycemia was 11.82%. According to the occurrence of neonatal hypoglycemia, the newborns were divided into the control group (n = 776, no hypoglycemia) and the observation group (n = 104, hypoglycemia occurred). The mean maternal age of the observation group was 32.54 ± 5.13 years and the mean maternal age of the control group was 31.02 ± 7.18 years. There were significant differences in pre-pregnancy overweight or obesity, delivery mode, maternal blood sugar control effect between the 2 groups of GDM women (P < .05). There were no statistically significant intergroup differences in baseline characteristics, such as number of parturient, sex of newborn, preterm delivery of newborn, low birth weight of newborn, and maternal occupation. Participants demographics characteristics are summarized in Table 1.
Table 1.
Demographics characteristics of patients.
| Variables | Control group (n = 776) | Observation group (n = 104) | t/χ2 | P |
|---|---|---|---|---|
| Maternal age (yr) | 31.02 ± 7.18 | 32.54 ± 5.13 | 1.043 | .159 |
| Number of parturient (times) | 1.43 ± 0.36 | 1.37 ± 0.23 | 0.827 | .732 |
| Mode of delivery | ||||
| Vaginal delivery | 556 (71.65) | 24 (23.08) | 96.296 | <.001 |
| Cesarean section | 220 (28.35) | 80 (76.92) | ||
| Overweight or obese before pregnancy | ||||
| Yes | 112 (14.43) | 80 (76.92) | 209.947 | <.001 |
| No | 664 (85.57) | 24 (23.08) | ||
| Effect of blood glucose control on parturient | ||||
| Good | 636 (81.96) | 60 (57.69) | 32.656 | <.001 |
| Be unsatisfactory | 140 (18.04) | 44 (42.31) | ||
| Sex of newborn | ||||
| Male | 408 (52.58) | 48 (46.15) | 1.516 | .218 |
| Female | 368 (47.42) | 56 (53.85) | ||
| Preterm delivery of newborn | ||||
| Yes | 36 (4.64) | 8 (7.69) | 1.80 | .179 |
| No | 740 (95.36) | 96 (92.31) | ||
| Low birth weight of newborn | ||||
| Yes | 12 (1.55) | 4 (3.85) | 2.717 | .099 |
| No | 764 (98.45) | 100 (96.15) | ||
| Maternal occupation | ||||
| Staff | 149 (19.20) | 19 (18.27) | 5.089 | .165 |
| Professional and technical personnel | 33 (4.25) | 4 (3.85) | ||
| Freelance occupation | 25 (3.22) | 8 (7.69) | ||
| Other | 569 (73.32) | 73 (70.19) | ||
3.2. Multivariate analysis of neonatal hypoglycemia in parturient women with GDM
Through univariate analysis, the relevant indicators with statistical significance were substituted into the logistic model for multivariate analysis. Taking neonatal hypoglycemia in parturient with GDM (defined “no”=0, “yes”=1) as dependent variable, logistic regression analysis was conducted. The results showed that overweight or obesity before pregnancy, poor blood glucose control, and mode of delivery in GDM parturient were all risk factors for neonatal hypoglycemia (Table 2).
Table 2.
Multiple logistic analysis of obstetrical risk factors of hypoglycemia in 2 groups of newborns.
| Variables | Β value | SE | Wals | P value | OR (95% CI) |
|---|---|---|---|---|---|
| Overweight or obese before pregnancy | 1.206 | 0.303 | 15.842 | <.001 | 3.340 (1.844–6.049) |
| Maternal blood glucose control | 1.852 | 0.558 | 11.016 | .001 | 6.373 (2.135–19.024) |
| Mode of delivery | 0.302 | 0.273 | 1.224 | 0.269 | 1.353 (0.792–2.310) |
CI = confidence interval, OR = odds ratio, SE = standard error.
3.3. The clinical data between groups of pregnant women with different HbA1c levels of GDM
Compared with the pre-delivery HbA1c < 6% group, the GDM pregnant women with pre-delivery HbA1c ≥ 6% had fasting blood glucose values in the OGTT test, blood glucose values 1 hour after taking sugar and blood glucose levels were significantly increased 2 hours after taking sugar (P < .05). And the birth weight of newborns increased significantly (P < .05) (Table 3).
Table 3.
Clinical data among pregnant women with different HbA1c levels of GDM.
| Variables | HbA1c < 6% (n = 656) | HbA1c ≥ 6% (n = 224) | t/χ2 | P |
|---|---|---|---|---|
| Gestational age (d) | 251.36 ± 22.45 | 253.19 ± 23.87 | 0.518 | .913 |
| Birth weight (kg) | 3.12 ± 0.67 | 3.59 ± 0.71 | 4.464 | .005 |
| OGTT fasting (mmol/L) | 5.76 ± 2.31 | 6.83 ± 1.45 | 3.252 | .012 |
| OGTT 1h (mmol/L) | 10.34 ± 1.81 | 12.57 ± 1.42 | 8.377 | .009 |
| OGTT 2h (mmol/L) | 8.83 ± 1.42 | 11.34 ± 3.35 | 7.785 | .027 |
| Neonatal respiratory distress syndrome | 128 (19.51) | 40 (17.86) | 0.296 | .586 |
| APagr 1 min ≤ 7 | 121 (18.45) | 48 (21.43) | 0.958 | .328 |
| APagr 5 min ≤ 7 | 20 (3.05) | 4 (1.79) | 1.004 | .316 |
| Placental abnormality | 104 (15.85) | 28 (12.50) | 1.473 | .225 |
| Amniotic fluid abnormality | 104 (15.85) | 28 (12.50) | 1.473 | .225 |
| Prenatal corticosteroid use | 108 (16.46) | 44 (19.64) | 1.181 | .277 |
GDM = gestational diabetes mellitus, HbA1c = hemoglobin A1c.
3.4. Correlation between HbA1c of pregnant women before delivery and initial blood glucose of newborns with GDM
We analyzed the correlation between HbA1c of pregnant women with GDM before delivery and initial blood glucose of newborns. The initial postnatal blood glucose of neonates born to GDM pregnant women with HbA1c ≥ 6% before delivery was significantly lower than that of those with HbA1c < 6% (P < .05) (Fig. 1).
Figure 1.
The initial blood glucose values of newborns delivered by pregnant women with different HbA1c in GDM. GDM = gestational diabetes mellitus, HbA1c = hemoglobin A1c.
3.5. Correlation between HbA1c of pregnant women with GDM before delivery and blood glucose of their newborns after birth
We analyzed the correlation between the HbA1c of pregnant women with GDM before delivery and the blood glucose of newborns after birth. The fluctuation value of blood glucose after delivery in GDM pregnant women with HbA1c ≥ 6% was significantly higher than that in HbA1c < 6% group (P < .05) (Fig. 2).
Figure 2.
The blood glucose fluctuations of newborns delivered by pregnant women with different HbA1c in GDM after birth. GDM = gestational diabetes mellitus, HbA1c = hemoglobin A1c.
3.6. Correlation between HbA1c of pregnant women with GDM before delivery and abnormal glucose metabolism in newborns
We analyzed the correlation between HbA1c before delivery and abnormal glucose metabolism in newborns of pregnant women with GDM. The HbA1c level of pregnant women with GDM before delivery was entered the binary logistic regression model as a binary variable. The results showed that abnormal glucose metabolism in newborn (odds ratio [OR]: 2.43, 95% confidence interval [CI]: 1.12–4.73) and neonatal hypoglycemia (OR: 3.04, 95% CI: 1.33–5.79) were a risk factor. We also conducted the logistic analysis to evaluate the correlation between HbA1c before delivery and abnormal glucose metabolism in newborns of pregnant women with GDM through adjusting some potential factors: age, birth weight. The results were still significant in the abnormal glucose metabolism in newborn (OR: 2.84, 95% CI: 1.23–6.63) and neonatal hypoglycemia (OR: 3.64, 95% CI: 1.46–8.18) (Table 4).
Table 4.
The correlation between HbA1c of pregnant women before delivery and abnormal glucose metabolism in newborns.
| Group | OR (95% CI) | aOR (95% CI) |
|---|---|---|
| Abnormal glucose metabolism in newborn | 2.43 (1.12–4.73) | 2.84 (1.23–6.63) |
| Neonatal hypoglycemia | 3.04 (1.33–5.79) | 3.64 (1.46–8.18) |
Adjust confounding factors including age, birth weight.
aOR = adjust odds ratio, CI = confidence interval, HbA1c = hemoglobin A1c, OR = odds ratio.
4. Discussion
During second and third trimester of pregnancy, the increase of anti-insulin substances will lead to the decrease of maternal insulin sensitivity and the increase of insulin secretion. Some pregnant women are unable to adapt to this compensatory disease is an important reason for the formation of GDM. It is reported that the incidence of GDM is 4.3% to 5.1%.[14,15] Although most GDM can return to normal after delivery, persistent hyperglycemia during pregnancy still causes inevitable damage to maternal and infant health. It is of great significance to do a good job in obstetrical management of high-risk pregnant people with GDM. Neonatal hypoglycemia is a common adverse pregnancy outcome in parturient with GDM. Although newborns break away from the maternal hyperglycemia environment after delivery, hyperinsulinemia still exist. If sugar is not replenished in time, serious cases of hypoglycemia can directly endanger their lives. Obstetrical clinical practice shows that most hypoglycemia newborns have no obvious symptoms in the early stage after birth, but persistent hypoglycemia is easy to cause neonatal brain cell necrosis and even irreversible brain nerve injury.[16]
It has been reported that maternal blood glucose of GDM > 7.2mmol/L is a high-risk factor of neonatal hypoglycemia, so it is particularly important to actively control the blood glucose level of pregnant women. However, the causes of neonatal hypoglycemia are complicated.[17] In addition to GDM factors, fully grasping the relevant factors affecting the occurrence of neonatal hypoglycemia is the key for obstetrics to formulate reasonable prevention and intervention measures and to reduce the occurrence of this adverse pregnancy outcome. This study showed that the incidence of neonatal hypoglycemia in 880 parturients with GDM was 11.82%, which was lower than 20.88% in Huang et al[18] Univariate analysis between groups showed that GDM maternal blood sugar control in the observation group was significantly lower than that in the control group. In addition, the proportion of pre-pregnancy obesity, overweight and improper feeding in the observation group was significantly higher than that in the control group. Further multivariate Logistic analysis showed that pre-pregnancy maternal overweight or obesity, poor blood sugar control of GDM mothers, and improper neonatal feeding were risk factors for neonatal hypoglycemia. Pan and Gu[19] reported the conclusions are consistent with our result, which provided a strong basis for obstetrics to actively prevent the occurrence of neonatal hypoglycemia.
Pre-pregnancy obesity or overweight is closely related to neonatal blood sugar. Wang and Luo[20] reported that pre-pregnancy BMI ≥ 25 kg/m2 was a risk factor for GDM and neonatal hypoglycemia. This study adopted the “Chinese Adult Overweight and Obesity Prevention and Control Guidelines” standard and regarded BMI ≥ 24 kg/m2 as overweight. The results showed that pre-pregnancy obesity or overweight in GDM women were risk factors for neonatal hypoglycemia, which was consistent with the above reports. The internal mechanism may be that maternal obesity or overweight before pregnancy can easily lead to the increase of blood glucose, free fatty acid and amino acid levels. Through placental stimulation, insulin β cells secrete more insulin and lead to the decrease of blood glucose level. The effect of blood glucose control in pregnant women with GDM has a direct impact on the occurrence of neonatal hypoglycemia. Pregnant women with GDM should actively strengthen blood glucose monitoring and take measures such as diet and exercise drug therapy to control blood glucose level, which is an important link to correct hyperglycemia and reduce maternal and infant injury. In obstetrics, premature infants and low body weight often occur at the same time, both of which are risk factors for neonatal hypoglycemia. Preterm infants have significantly lower liver glycogen reserves and glucose metabolism than normal full-term infants. In addition, the gastrointestinal absorptive capacity and nutritional status of the body are poor and the body weight of most premature infants is obviously low, which is difficult to maintain the stable state of blood glucose. It is worth noting that the late preterm infants with a gestational age of 34 to 36 weeks are similar in physique and maturity to full-term infants, so obstetric-related treatment is easy to be ignored. The incidence of blood sugar, the mortality rate is still higher than that of term infants, so obstetrics should pay attention to the prevention and treatment of hypoglycemia in premature infants. The risk of hypoglycemia in hypothermic neonates is significantly increased. The reason may be that the thermoregulatory mechanisms of these newborns are not well developed, increasing the consumption of energy substances such as glucose. Enzyme activity leads to hypoglycemia under the combined effect, so it is necessary to strictly monitor the temperature of newborns and keep warm. In addition, the improper feeding method of newborns is also a risk factor for hypoglycemia. Newborns need to be fed promptly after birth to obtain energy substances such as glucose, especially during the 6-hour postnatal period when hypo glycemia is high.
HbA1c can reflect the blood glucose exposure level of the body in the past 2 to 3 months.[21,22] This may be related to the rapid change of insulin resistance in pregnant women with GDM. Previous studies mostly used the HbA1c level of GDM women in the second trimester of pregnancy to diagnose GDM as an index to reflect blood glucose exposure to study the correlation between HbA1c level and maternal and fetal outcome. However, with the enhancement of health awareness of the population and the attention of maternal and child institutions to the management of high-risk pregnant women, more and more pregnant women with GDM will pay more attention to their own blood sugar level after diagnosis. Through increasing exercise, diet control, and even the use of hypoglycemic drugs to control blood sugar, the insulin resistance substances secreted by the placenta continue to secrete and the level of insulin resistance in the third trimester of pregnancy will increase.[23,24] Therefore, the level of HbA1c in the second trimester of pregnancy cannot accurately reflect the blood glucose level of GDM pregnant women when insulin resistance reaches its peak, nor can it reflect the intrauterine blood glucose exposure level of fetus before delivery. Therefore, the HbA1c value within 1 week before delivery was used to reflect the long-term intrauterine blood glucose exposure level of newborns from 2 to 3 months before delivery. The results suggested GDM pregnant women with high HbA1c level before delivery are strongly correlated with abnormal glucose metabolism in newborns, including neonatal hypoglycemia. It is indicated that the environment of intrauterine hyperglycemia will adversely affect fetal glucose metabolism, making them more prone to abnormal neonatal glucose metabolism after delivery.
Glucose is the only source of energy for neonatal brain development. Severe hypoglycemia will permanently damage the structure and memory function of the brain. For newborns, severe or persistent neonatal hypoglycemia will lead to acute and chronic neurological damage and even affect their preschool executive function and visual motor function. The occurrence of neonatal hypoglycemia is affected by many factors, but the abnormal glucose metabolism during pregnancy is an important factor that cannot be ignored. Previous studies have confirmed that pregnant women with GDM will significantly increase the risk of hypoglycemia in their newborns.[25,26] The blood glucose level of the fetus in the uterus is about 70% to 80% of that of the mother. the higher blood glucose level of the GDM mother will lead to a higher blood glucose level in the fetus, while the insulin in the mother cannot enter the fetal circulation through the placental barrier. So the higher glucose level in the fetus will stimulate the proliferation of fetal pancreatic cells, the fetus itself must secrete more insulin to maintain its normal blood sugar. With the ligation of the umbilical cord after delivery, the maternal energy supply is interrupted and the high level of insulin in the fetus makes the newborn prone to hypoglycemia. Consistent with previous studies, the results of this study showed that the HbA1c level of pregnant women with GDM before delivery was negatively correlated with the initial postnatal blood glucose value of their newborns. And according to the HbA1c control standards recommended by the American Diabetes Association guidelines, GDM pregnant women with poor HbA1c control before delivery (HbA1c ≥ 6%) have a particularly high risk of neonatal hypoglycemia. Therefore, the HbA1c level of pregnant women with GDM before delivery is a good index to predict the occurrence of neonatal hypoglycemia. This study also showed that the HbA1c of pregnant women with GDM before delivery was positively correlated with the fluctuation of blood glucose at 3 days after birth and the incidence of abnormal glucose metabolism in newborns, indicating that controlling the level of HbA1c during pregnancy in GDM pregnant women can maintain the stability of postnatal blood glucose levels, improve their glucose metabolism ability and help to ensure their health.
In the comparison of the general data of pregnant women and newborns with GDM between the 2 groups, there were significant differences in pre-pregnancy overweight or obesity, delivery mode, maternal blood glucose control effect and neonatal feeding norms between the 2 groups. It showed that the weight of pregnant women with GDM would directly affect the blood glucose level of newborns. Pregnant women should pay attention to weight control, adjust their living and eating habits, limit the intake of high-calorie foods, which will help to reduce the blood glucose level of newborns. The mode of delivery is also closely related to the occurrence of neonatal hypoglycemia and newborns delivered by cesarean section are more prone to hypoglycemia, so medical staff should strengthen health education for pregnant women and their families before delivery. To make them fully understand the disadvantages of cesarean section, it is necessary to encourage those who conform to the indication of natural delivery to give priority to natural delivery. The effect of blood glucose control of pregnant women is also directly related to the incidence of neonatal hypoglycemia. The comprehensive measures such as medicine, diet intervention, exercise intervention and blood glucose monitoring should be taken to reduce blood glucose level. Neonatal feeding norms have a lower risk of hypoglycemia, so medical staff should strengthen the feeding guidance to pregnant women after neonatal delivery and improve their health awareness and neonatal nursing skills as much as possible to make them feed scientifically. Logistic multivariate analysis showed that overweight or obesity of GDM parturient before pregnancy, poor blood glucose control of GDM parturient and improper feeding of newborns were all independent risk factors of neonatal hypoglycemia. These 3 factors have a greater impact on the occurrence of neonatal hypoglycemia. In clinic, appropriate measures should be taken in advance to avoid the occurrence of neonatal hypoglycemia. In the comparison of clinical data among pregnant women with different HbA1c levels, there were significant differences in fasting blood glucose value, 1 hour blood glucose value and 2-hour blood glucose value after taking glucose, and the newborn weight. The fasting blood glucose value, 1 hour blood glucose value and 2-hour blood glucose value after taking glucose were higher in those with HbA1c level ≥ 6%, and the newborn weight was also higher. The results showed that the level of HbA1c was positively correlated with the above indexes. Reasonable regulation of HbA1c level is an effective way to reduce blood glucose and neonatal weight.
5. Conclusions
In summary, the findings of this study indicate that pre-pregnancy overweight or obesity in women with GDM, inadequate blood glucose control during pregnancy, and suboptimal feeding practices for newborns are all risk factors for neonatal hypoglycemia. Moreover, HbA1c levels before delivery demonstrate a certain predictive value for abnormal glucose metabolism in newborns. Additionally, it is observed that HbA1c levels in pregnant women with GDM are associated with birth weight and the occurrence of large for gestational age infants. Therefore, implementing targeted prevention and intervention strategies based on obstetrical risk factors becomes pivotal in reducing the incidence of neonatal hypoglycemia.
Author contributions
Conceptualization: Yu Cao, Yun Yang, Juan Ma.
Data curation: Yu Cao, Lei Liu, Juan Ma.
Formal analysis: Yun Yang, Lei Liu.
Funding acquisition: Yu Cao, Yun Yang, Juan Ma.
Methodology: Yu Cao, Yun Yang, Lei Liu, Juan Ma.
Project administration: Lei Liu, Juan Ma.
Resources: Yu Cao, Juan Ma.
Software: Yu Cao, Yun Yang, Lei Liu.
Supervision: Yu Cao, Juan Ma.
Validation: Yu Cao, Lei Liu.
Visualization: Lei Liu.
Writing – original draft: Yu Cao.
Writing – review & editing: Juan Ma.
Abbreviations:
- ADA
- American Diabetes Association
- BMI
- body mass index
- CGM
- continuous blood glucose monitoring
- GDM
- gestational diabetes mellitus
- HbA1c
- hemoglobin A1c
YC and YY contributed equally to this work.
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Cao Y, Yang Y, Liu L, Ma J. Analysis of risk factors of neonatal hypoglycemia and its correlation with blood glucose control of gestational diabetes mellitus: A retrospective study. Medicine 2023;102:35(e34619).
Contributor Information
Yu Cao, Email: 63214532@qq.com.
Yun Yang, Email: 32145864@qq.com.
Lei Liu, Email: 325641578@qq.com.
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