Department of Obstetrics and Gynaecology, Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Obstetrics and Gynaecology, Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Diabetes Care. 2018 Jul;41(7):1385-1390. doi: 10.2337/dc18-0048. Epub 2018 Apr 13.
To assess the risk of neonatal hypoglycemia following diet-controlled and insulin-treated gestational diabetes mellitus (GDM) and how it relates to birth weight.
Prospective cohort study included term neonates born after GDM from January 2013 through December 2015 at the University Medical Center Utrecht (Utrecht, the Netherlands). Routine screening of neonatal blood glucose levels was performed at 1, 3, 6, 12, and 24 h after birth. Main outcome measures were neonatal hypoglycemia defined as blood glucose ≤36 mg/dL (severe) and ≤47 mg/dL (mild).
A total of 506 neonates were included, born after pregnancies complicated by GDM treated either with insulin (22.5%) or without insulin (77.5%). The incidence of mild and severe hypoglycemia was similar in the insulin-treated and diet-controlled groups (33 vs. 35%, = 0.66; and 20 vs. 21%, = 0.79). A birth weight >90th centile was seen in 17.2% of all infants. Although children with a birth weight >90th centile had the highest risk for hypoglycemia, the vast majority of hypoglycemia (78.6%) was detected in those with a birth weight <90th centile. Over 95% of all hypoglycemia occurred within 12 h after birth.
Routine screening for neonatal hypoglycemia following pregnancies complicated by GDM reveals high incidence of both mild and severe hypoglycemia for both diet-controlled and insulin-treated GDM and across the full range of birth weight centiles. We propose routine blood glucose screening for neonatal hypoglycemia within the first 12 h of life in all neonates after GDM, irrespective of maternal insulin use or birth weight.
评估饮食控制和胰岛素治疗的妊娠期糖尿病（GDM）后新生儿低血糖的风险及其与出生体重的关系。
前瞻性队列研究纳入了 2013 年 1 月至 2015 年 12 月在荷兰乌得勒支大学医学中心（Utrecht）分娩的 GDM 足月新生儿。在出生后 1、3、6、12 和 24 小时常规筛查新生儿血糖水平。主要结局指标为血糖≤36mg/dL（重度）和≤47mg/dL（轻度）的新生儿低血糖。
共纳入 506 例新生儿，母亲患有 GDM，分别接受胰岛素治疗（22.5%）和未接受胰岛素治疗（77.5%）。胰岛素治疗组和饮食控制组的轻度和重度低血糖发生率相似（33%比 35%，=0.66；20%比 21%，=0.79）。所有婴儿中，出生体重>第 90 百分位数的比例为 17.2%。尽管出生体重>第 90 百分位数的儿童低血糖风险最高，但绝大多数低血糖（78.6%）发生在出生体重<第 90 百分位数的儿童中。超过 95%的低血糖发生在出生后 12 小时内。
对 GDM 孕妇分娩的新生儿进行常规低血糖筛查显示，饮食控制和胰岛素治疗的 GDM 以及整个出生体重百分位数范围内均存在轻度和重度低血糖的高发生率。我们建议所有 GDM 新生儿在出生后 12 小时内常规进行新生儿低血糖筛查，无论母亲是否使用胰岛素或出生体重如何。
