Sarkar Subrata, Watman Jerry, Seigel Warren M, Schaeffer Henry A
Department of Pediatrics, Maimonides, Medical Center, Brooklyn, NY 11219, USA.
J Perinatol. 2003 Apr-May;23(3):223-8. doi: 10.1038/sj.jp.7210882.
Infants of gestational diabetes mellitus (GDM)-A1 women are unlikely to experience the marked excursion in maternal glucose levels that may characterize insulin-requiring GDM (class-A2) or insulin-dependent diabetes (IDDM). However, infants born to GDM-A1 women are traditionally managed like infants born to GDM-A2 or IDDM women.
To examine monitoring protocols for infants of GDM-A1 women, and to examine the efficacy of early and frequent feedings to prevent and to treat hypoglycemia.
A total of 92 of 101 infants born to GDM-A1 women (diabetic group) and 68 of 83 infants born to nondiabetic women (control group) at > or=36 weeks of gestation were prospectively monitored for the development of hypoglycemia and other morbidities. Blood glucose screening was performed in the diabetic group every 30-60 minutes three times, starting soon after birth and then at 3-hour intervals for 24 hours. Liberal feedings were started shortly after birth and provided every 3 hours for at least 24 hours. All women with GDM-A1 had an HbA1c measured before delivery.
Both the diabetic and control groups had similar demographics, including LGA incidence. Blood glucose readings before feedings were low (<40 mg/dl) in 24 of 92 infants (26.1%) from the diabetic group and in 20 of 68 control infants (29%). After the start of oral feedings, all but four diabetic and three control infants had subsequent glucose readings > or =40 mg/dl. No infant had symptoms of hypoglycemia and none from the diabetic group had birth trauma, hypoxic-ischemic encephalopathy, polycythemia, hypocalcemia, or hypomagnesemia. Hypoglycemic episodes in the infants from the diabetic group could be managed with oral feedings alone. Birth weight, gestational age, sex, Apgar scores, and maternal HbA1c levels could not predict low glucose readings on initial screening in infants from the diabetic group.
The incidence of hypoglycemia in infants born to GDM-A1 women at > or =36 weeks of gestation is similar to control infants born to nondiabetic women. Low blood glucose levels during the first few hours of life can be prevented or treated with early and frequent oral feeding.
妊娠期糖尿病（GDM）-A1型女性的婴儿不太可能经历母体血糖水平的显著波动，而这种波动可能是需要胰岛素治疗的GDM（A2类）或胰岛素依赖型糖尿病（IDDM）的特征。然而，传统上，GDM-A1型女性所生婴儿的管理方式与GDM-A2型或IDDM型女性所生婴儿相同。
研究GDM-A1型女性婴儿的监测方案，并探讨早期频繁喂养预防和治疗低血糖的效果。
前瞻性监测101例GDM-A1型女性所生婴儿中的92例（糖尿病组）和83例非糖尿病女性所生婴儿中的68例（对照组）在妊娠≥36周时低血糖及其他疾病的发生情况。糖尿病组在出生后不久开始，每30-60分钟进行3次血糖筛查，然后每3小时进行1次，共24小时。出生后不久开始自由喂养，每3小时进行1次，至少持续24小时。所有GDM-A1型女性在分娩前均检测了糖化血红蛋白（HbA1c）。
糖尿病组和对照组的人口统计学特征相似，包括大于胎龄儿（LGA）发生率。糖尿病组92例婴儿中有24例（26.1%）在喂养前血糖读数低（<40mg/dl），对照组68例婴儿中有20例（29%）。开始口服喂养后，除4例糖尿病组婴儿和3例对照组婴儿外，其他婴儿随后的血糖读数均≥40mg/dl。没有婴儿出现低血糖症状，糖尿病组也没有婴儿出现产伤、缺氧缺血性脑病、红细胞增多症、低钙血症或低镁血症。糖尿病组婴儿的低血糖发作仅通过口服喂养即可处理。出生体重、孕周、性别、阿氏评分和母体HbA1c水平均不能预测糖尿病组婴儿初次筛查时的低血糖读数。
妊娠≥36周的GDM-A1型女性所生婴儿的低血糖发生率与非糖尿病女性所生对照婴儿相似。生命最初几小时的低血糖水平可通过早期频繁口服喂养预防或治疗。
