Journal
PEDIATRICS
Volume 126, Issue 6, Pages E1545-E1552Publisher
AMER ACAD PEDIATRICS
DOI: 10.1542/peds.2009-2257
Keywords
size at birth; neonatal hypoglycemia; cord C-peptide levels; maternal glucose levels
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Funding
- National Institute of Child Health and Human Development
- National Institute of Diabetes, Digestive, and Kidney Diseases [R01-HD34242, R01-HD34243]
- National Center for Research Resources [M01-RR00048, M01-RR00080]
- American Diabetes Association
- Kaiser Permanente Medical Center [RD04/0002756]
- Royal College of Physicians of Edinburgh
- Howard and Carol Bernick Family Foundation
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OBJECTIVE: The goal was to describe the temporal pattern of neonatal plasma glucose levels and associations with maternal glucose levels, cord serum C-peptide levels, and neonatal size and adiposity. METHODS: A total of 17 094 mothers and infants were included in the Hyperglycemia and Adverse Pregnancy Outcome Study (15 centers in 9 countries). Mothers underwent a 75-g, 2-hour, oral glucose tolerance test (OGTT) at 24 to 32 weeks of gestation. Cord blood and neonatal blood samples were collected. Biochemical neonatal hypoglycemia was defined as glucose levels of <10th percentile (2.2 mmol/L). Clinically identified hypoglycemia was ascertained through medical record review and associations were assessed. RESULTS: Plasma glucose concentrations were stable during the first 5 hours after birth. Maternal glucose levels were weakly positively associated with biochemical neonatal hypoglycemia (odds ratios: 1.07-1.14 for 1-SD higher OGTT glucose levels). Frequency of neonatal hypoglycemia was higher with higher cord C-peptide levels (odds ratio: 11.6 for highest versus lowest C-peptide category). Larger and/or fatter infants were more likely to have hypoglycemia (P < .001), and infants with hypoglycemia tended to have a higher frequency of cord C-peptide levels of >90th percentile. CONCLUSIONS: Mean neonatal plasma glucose concentrations varied little in the first 5 hours after birth, which suggests normal postnatal adjustment. Biochemical and clinical hypoglycemia were weakly related to maternal OGTT glucose measurements but were strongly associated with elevated cord serum C-peptide levels. Larger and/or fatter infants were more likely to develop hypoglycemia and hyperinsulinemia. These relationships suggest physiologic relationships between maternal glycemia and fetal insulin production. Pediatrics 2010;126:e1545-e1552
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