Schaefer-Graf Ute M, Rossi Rainer, Bührer Christoph, Siebert Gerda, Kjos Siri L, Dudenhausen Joachim W, Vetter Klaus
Department of Obstetrics, Vivantes Medical Center Neukoelln, Charité, Campus Virchow-Klinikum, Humboldt-University, Berlin, Germany.
Am J Obstet Gynecol. 2002 Oct;187(4):913-7. doi: 10.1067/mob.2002.126962.
The purpose of this study was to investigate the rate of hypoglycemia in large-for-gestational-age infants of nondiabetic mothers in relation to maternal or neonatal risk factors.
Hospital charts of all term large-for-gestational-age infants born between 1994 and 1998 (n = 1136) were analyzed for the rate of neonatal hypoglycemia (capillary glucose level, < or =30 mg/dL) during the first 24 hours of life. Infants of women with preexisting or gestational diabetes mellitus were excluded (n = 180). Neonatal glucose testing was performed at 1 or 2 hours of life, with subsequent measurements every 4 to 6 hours. Maternal and neonatal parameters were compared between neonates with and without hypoglycemia, including recent oral glucose tolerance test values in those women who were tested (n = 358).
Of 956 infants, 69 infants (7.2%) were not tested for hypoglycemia. In the remaining 887 infants, hypoglycemia occurred in 142 infants (16%) within the first 24 hours of life. The incidence of hypoglycemia decreased sharply during the first few hours of life, from 9.2% within the first hour of life, to 3.5% between 2 to 5 hours (cumulative) of life, and 2.4% between 6 and 24 hours of life. Gestational age at delivery was the only neonatal parameter that differed significantly between infants with and without hypoglycemia (39.5 vs 39.3 weeks, P =.01). The antenatal 1-hour oral glucose tolerance test value was the only predictive maternal parameter (141.5 vs 163.0 mg/dL, P <.006). There was an incremental risk of hypoglycemia with increasing 1-hour oral glucose tolerance test values, with hypoglycemia rates of 2.5%, 9.3%, 22.0%, and 50.0% that were associated with maternal 1-hour glucose values of <120, 120-179, 180-239, and > or =240 mg/dL, respectively (P <.05, for all comparisons).
Routine glucose testing is indicated in large-for-gestational-age newborn infants of nondiabetic mothers. The 1-hour glucose value of the maternal oral glucose tolerance test is a fairly good predictor of subsequent neonatal hypoglycemia. A single elevated 1-hour value of > or =180 mg/dL markedly increases the risk of neonatal hypoglycemia.
本研究旨在调查非糖尿病母亲的大于胎龄儿发生低血糖的几率，并分析其与母亲或新生儿危险因素之间的关系。
对1994年至1998年期间出生的所有足月大于胎龄儿（n = 1136）的医院病历进行分析，以确定其出生后24小时内新生儿低血糖（毛细血管血糖水平≤30 mg/dL）的发生率。患有孕前或妊娠期糖尿病的妇女所生婴儿被排除在外（n = 180）。在出生后1或2小时进行新生儿血糖检测，随后每4至6小时测量一次。比较发生低血糖和未发生低血糖的新生儿的母亲和新生儿参数，包括对进行过检测的妇女（n = 358）最近的口服葡萄糖耐量试验值。
956例婴儿中，69例（7.2%）未进行低血糖检测。在其余887例婴儿中，142例（16%）在出生后24小时内发生低血糖。低血糖发生率在出生后的最初几个小时内急剧下降，从出生后第1小时内的9.2%，降至出生后2至5小时（累计）的3.5%，以及出生后6至24小时的2.4%。分娩时的孕周是发生低血糖和未发生低血糖的婴儿之间唯一有显著差异的新生儿参数（39.5周对39.3周，P = 0.01）。产前1小时口服葡萄糖耐量试验值是唯一具有预测性的母亲参数（141.5对163.0 mg/dL，P < 0.006）。随着1小时口服葡萄糖耐量试验值升高，发生低血糖的风险增加，母亲1小时血糖值<120、120 - 179、180 - 239和≥240 mg/dL时，低血糖发生率分别为2.5%、9.3%、22.0%和50.0%（所有比较P < 0.05）。
非糖尿病母亲的大于胎龄新生儿应进行常规血糖检测。母亲口服葡萄糖耐量试验的1小时血糖值是随后新生儿低血糖的一个相当好的预测指标。单次1小时血糖值≥180 mg/dL会显著增加新生儿低血糖的风险。
