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Risk of hypoglycemia by anthropometric measurements in neonates of mothers with diabetes

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Abstract

Macrosomia in neonates of diabetic women is a risk factor for neonatal hypoglycemia, with an over-risk for asymmetric macrosomia. This study aimed to study the association between anthropometric measurements and hypoglycemia in neonates of mothers treated for gestational diabetes. This is a secondary analysis of the INDAO trial study conducted between May 2012 and November 2016 in 13 French tertiary care university hospitals in 890 pregnant women with gestational diabetes treated with either insulin or glyburide. Neonatal anthropometric measurements were birthweight and weight-length ratio (WLR, defined as birth weight/length). Neonatal hypoglycemia was defined as capillary blood glucose below 36 mg/dL (2 mmol/L) or below 45 mg/dL (2.5 mmol/L) associated with clinical signs after 2 h of life. Their relationships were modeled with logistic regressions using fractional polynomials. Extreme categories of birthweight or WLR adjusted for gestational age at birth and sex were defined as Z-score <  −1.28 or > 1.28. These categories were compared to Z-score between −1.28 and 1.28 by estimating odds ratios and confidence intervals for neonatal hypoglycemia. Neonatal hypoglycemia occurred in 9.1% of cases. The relationship between birthweight and WLR Z-scores and neonatal risk of hypoglycemia adjusted for maternal treatment was a U-shaped curve. Adjusted odds ratios for the risk of hypoglycemia were 9.6 (95% CI 3.5, 26.8) and 2.3 (95% CI 1.1, 4.9) for WLR Z-score below −1.28 and above 1.28, respectively, compared with WLR Z-score between −1.28 and 1.28.

   Conclusion: Birthweight Z-score was associated with the risk of neonatal hypoglycemia in neonates from mothers treated for gestational diabetes. The risk of neonatal hypoglycemia was increased for both extreme birthweight Z-scores, regardless of maternal treatment. Small for gestational age neonates of diabetic mothers require special attention for the risk of neonatal hypoglycemia.

What is Known:

• Macrosomia in neonates of diabetic women is a risk factor for neonatal hypoglycemia, with an over-risk for asymmetric macrosomia. Few retrospective studies have assessed the risk for neonatal hypoglycemia among small for gestational age neonates born to diabetic mothers.

What is New:

• The risk of neonatal hypoglycemia among neonates of diabetic mothers increased for both low and high weight-length ratio, regardless of maternal medicinal treatment, gestational age at birth, and sex of the newborn.

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Abbreviations

LGA:

Large for gestational age

SGA:

Small for gestational age

WG:

Weeks of gestation

WLR:

Weight/length ratio

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Acknowledgements

We thank the women who participated in this study, the midwives and obstetricians involved in their care, and David Marsh for his help in editing this manuscript.

Funding

This study was funded by a research grant from the French Ministry of Health and was sponsored by Paris Public Hospitals (AP-HP, Assistance Publique-Hôpitaux de Paris), via its Clinical Research Department.

Author information

Authors and Affiliations

  1. Department of Gynecology-Obstetrics, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78, avenue du Général Leclerc, 94275, Le Kremlin-Bicêtre, Cedex, France

    Hanane Bouchghoul & Marie-Victoire Senat

  2. Université Paris-Saclay, UVSQ, CESP, 94807, Villejuif, Inserm, France

    Hanane Bouchghoul, Jean Bouyer & Marie-Victoire Senat

  3. Department of Neonatology, Bretonneau Hospital, François Rabelais University, 37000, Tours, France

    Delphine Mitanchez Mokhtari

  4. INSERM UMR_S 938 Saint Antoine Research Center, 75012, Paris, France

    Delphine Mitanchez Mokhtari

  5. Department of Gynecology-Obstetrics, Assistance Publique-Hôpitaux de Paris, Antoine Béclère Hospital, Clamart, France

    Alexandra Letourneau

Authors
  1. Hanane Bouchghoul
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  2. Delphine Mitanchez Mokhtari
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  3. Alexandra Letourneau
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  4. Jean Bouyer
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  5. Marie-Victoire Senat
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Contributions

H. Bouchghoul and D. Mitanchez conceptualized and designed the study, carried out the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. A. Letourneau collected data and reviewed and revised the manuscript. J. Bouyer and M-V. Senat conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Hanane Bouchghoul.

Ethics declarations

Ethics approval

The INDAO trial protocol, including this ancillary study for which patients provided additional informed consent, was approved by the ethics committee of the Poissy St-Germain Hospital (France) and registered in clinicaltrials.gov (NCT01731431). Data were collected by research staff members from medical records including medical history and outcome data.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Bouchghoul, H., Mokhtari, D.M., Letourneau, A. et al. Risk of hypoglycemia by anthropometric measurements in neonates of mothers with diabetes. Eur J Pediatr 181, 3483–3490 (2022). https://doi.org/10.1007/s00431-022-04532-6

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