Neonatal hypoglycaemia in infants of diabetic mothers

Objective: To determine whether umbilical cord blood glucose correlates wit h subsequent hypoglycaemia after birth in infants of well-controlled diabet ic mothers. Methodology: Thirty-eight term infants of well-controlled diabetic mothers were enrolled. Five mothers had pre-existing diabetes. Of the 33 gestationa l diabetic mothers, 16 were managed on insulin and 17 on diet. Maternal blo od glucose was maintained between 4 and 8 mmol/L during labour and delivery . Infants' plasma glucose levels were measured from venous cord blood and s erially, at less than 30 min, 1 h and 2 h of life by glucose hexokinase met hod. Blood glucose levels were further monitored by bedside Dextrostix for 24 h. Results: Eighteen (47%) infants developed hypoglycaemia (blood glucose leve l less than 2 mmol/L) during the first 2 h of life. There was no difference in the cord blood glucose levels between infants with or without hypoglyca emia (3.7 +/- 1.1 vs 4.5 +/- 1.1 mmol/L, respectively). Infants of mothers with diabetes diagnosed prior to 28 weeks gestation were at a higher risk o f developing hypoglycaemia (8 of 10 vs 10 of 28, OR 7.2, 95% CI 1.3-40.7). Hypoglycaemic infants were of significantly higher birthweight, and were mo re likely to be born to Caucasian mothers and by Caesarean section. Raised maternal fructosamine blood level, the need for insulin treatment or the in fant's haematocrit were not different between infants with or without hypog lycaemia. Conclusions: In well-controlled diabetic mothers, the incidence of early hy poglycaemia in infants is still high, particularly in those mothers who had a longer duration of diabetes. Cord blood glucose level did not identify t he infants with hypoglycaemia.