Diabetes
Poster Session 3
Misgav Rottenstreich, MBA, MD (he/him/his)
Clinical Fellow
McMaster University
Hamilton, ON, Canada
Howard Berger, MD
University of Toronto
Thornhill, ON, Canada
Swati Agrawal, MD, MSCR
Hamilton Health Sciences
Toronto, ON, Canada
Homero Flores Mendoza, MD
McMaster University
Hamilton, ON, Canada
Gharid Nourallah Bekdache, MD
McMaster University
Hamilton, ON, Canada
Ipsita Goswami, MD
McMaster University
Hamilton, ON, Canada
Bryon DeFrance, MD
McMaster University
Hamilton, ON, Canada
Jon F. Barrett, MD, PhD
Chair
Sunnybrook Health Science, University of Toronto
Toronto, ON, Canada
Eran Ashwal, MD
Clinical Fellow
McMaster University
North York, Tel Aviv, Canada
Neonatal hypoglycemia is closely linked to abnormal maternal glycemic control and aberrant fetal growth. To delve deeper into this relationship, our study aims to evaluate the influence of two significant factors - gestational diabetes (GDM) and large-for-gestational-age (LGA) status - on the risk of neonatal hypoglycemia at term.
Study Design:
This retrospective cohort study enrolled liveborn singleton pregnancies born at term (≥37 weeks) in a tertiary center (2011-2022). Exclusion criteria included pre-gestational diabetes mellitus, neonatal birthweight < 10th centile, and known fetal genetic/structural abnormalities. The study population was categorized into four distinct groups: (1) Pregnancies without GDM or LGA (birthweight > 90th centile) – reference group; (2) pregnancies without GDM, but with LGA neonate; (3) pregnancies complicated with GDM, without LGA neonate; and (4) pregnancies with GDM and LGA neonate. The primary outcome of interest was the occurrence of neonatal hypoglycemia. Multivariable logistic regressions were performed.
Results:
A total of 22,836 patients were included in the study, with 18,889 (82.7%) pregnancies without GDM or LGA (group 1 – reference group), 1,640 (7.2%) with LGA (group 2), 1,947 (8.5%) with GDM (group 3), and 360 (1.6%) with both GDM and LGA. Notably, the groups exhibited variations in sociodemographic and obstetrical characteristics. The rates of neonatal hypoglycemia were 3.6%, 17.3%, 19.1%, and 43.6%, without significant differences between groups 2 and 3. The multivariate analysis, which controlled for hypertensive disorders of pregnancy, gestational age at delivery, mode of delivery, and birth injury, found that both LGA and GDM were significantly and independently associated with neonatal hypoglycemia. Interestingly, when presented together, LGA and GDM exhibited a synergistic effect.
Conclusion:
The findings underscore the importance of considering maternal glycemic control and fetal growth patterns in assessing neonatal hypoglycemia risk and highlight the need for targeted interventions and monitoring strategies to optimize neonatal health outcomes.