Reexamining intrapartum glucose control in patients with diabetes and risk of neonatal hypoglycemia

Objective Compare the incidence of hypoglycemia in neonates born to patients with diabetes, based on last maternal glucose before delivery. Study design Cohort of singleton births from individuals with pregestational and gestational diabetes (GDM) from 2017 to 2019. Results We included 853 deliveries. Maternal hyperglycemia before delivery was associated with 1.8-fold greater risk of neonatal hypoglycemia (glucose < 45 mg/dL) in patients with GDM on medication (adjusted risk ratio (aRR): 1.8; 95% CI: 1.1-2.7), compared with euglycemia. This association was not seen in diet-controlled GDM (0.5; 0.23-1.1), nor in Type 1 (1.1; 0.88-1.4), or Type 2 pregestational diabetes (1.1; 0.61-1.9). Further, pregestational diabetes, compared to GDM, regardless of intrapartum maternal glucose control, was associated with neonatal hypoglycemia and NICU admission. Conclusion Maternal hyperglycemia before delivery only carried a higher risk of neonatal hypoglycemia in those with GDM on medications. Other interventions to reduce neonatal hypoglycemia are needed.