A prospective controlled study of neonatal morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-class Al).

OBJECTIVE: 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.

AIMS: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.