IMPACT OF METABOLIC CONTROL OF DIABETES DURING PREGNANCY ON NEONATAL HYPOCALCEMIA - A RANDOMIZED STUDY

Objective: To test the hypothesis that strict control of diabetes duri ng pregnancy can reduce the risk for neonatal hypocalcemia in infants of diabetic mothers. Methods: One hundred thirty-seven pregnant women with insulin-dependent diabetes enrolled before 9 weeks' gestation wer e randomized to one of two treatment groups. In 68 subjects, the goals were fasting blood glucose level less than 4.44 mmol/L (80 mg/dL) and 1.5-hour postprandial blood glucose level less than 6.66 mmol/L (120 mg/dL) (strict control), whereas in 69 the goals were fasting blood gl ucose level less than 5.55 mmol/L (100 mg/dL) and 1.5-hour postprandia l glucose level less than 7.77 mmol/L (140 mg/dL) (customary control). Results: Infants in the strict control group had a significantly lowe r rate of hypocalcemia (mean calcium less than 8.0 mg/dL in term infan ts and less than 7.0 mg/dL in preterm infants) than infants in the cus tomary control group (17.6 versus 31.9%; P<.05). Using logistic regres sion analysis and after adjusting for the effects of gestational age, asphyxia, and White class on hypocalcemia, the difference between grou ps remained significant. The lowest infant serum calcium concentration correlated significantly with maternal glycohemoglobin A, concentrati on at delivery (P=.03), gestational age (P=.0001), and the lowest seru m magnesium concentration (P=.0001). Conclusion: Strict management of diabetes in pregnancy is associated with a reduction in the rate of ne onatal hypocalcemia.