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Neonatal Hypoglycemia:

An Obstetric Perspective

James deVente MD/PhD


East Carolina University Brody School of Medicine
Department of Obstetrics and Gynecology
VIDANT Medical Center
VIDANT Women’s Center
Disclosures

u None
Objectives

1. Appreciate the obstetric patients at greatest risk for


delivering infants with neonatal hypoglycemia
2. Appreciate the obstetric issues associated with “acute”
neonatal hypoglycemia
3. Appreciate the obstetric issues associated with “chronic”
neonatal hypoglycemia
4. What can obstetric providers do to decrease the chances of
neonatal hypoglycemia?
Neonatal hypoglycemia:
Common Risk factors

1. Intrauterine Growth Restriction/Small for Gestational Age


infants
2. Infant of Diabetic Mothers/Large for Gestational Age infants
3. Late Preterm Infants (34 to 36.6 weeks)

Neonatal Hypoglycemia. Abramowski A; Hamdan AH. StatPearls Publishing. 2019 01. UI:30725790
Neonatal Hypoglycemia:
“Acute” intrapartum-associated issues

1. Poorly controlled blood sugars (>200 mg/dl) in diabetic


mothers adjacent to delivery
2. Antenatal Corticosteroids (24 23 22? weeks -34 weeks)
3. Antenatal Late Preterm Steroids (34 weeks – 36 6/7 weeks)

ALPS trail:
Please use Caution
and select your
patients carefully
Neonatal Hypoglycemia. Abramowski A; Hamdan AH. StatPearls Publishing. 2019 01. UI:30725790
Maternal Diabetes:
Intrapartum glucose control
Fact: Marked increase in neonatal hyperglycemia in mothers with intrapartum
blood sugars >200 mg/dl Critical
Thinking is
1. Mothers with poorly controlled or difficult to control (brittle) glucose levels Key
should be managed with insulin infusion (insulin ggt, endotool, glucomander)
early during labor so that blood sugars are normalized (goal:110 mg/dl) many
hours prior to delivery.

2. Mothers with well controlled diabetes but have received antenatal steroids will
be difficult to control over next five days… may need insulin ggt

3. During “active phase” of labor blood sugars should be monitored hourly!!!!


You can’t find
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Mitanchez D, Yzydorczyk C, Siddeek B, Boubred F, Benahmed M, Simeoni U. The offspring of the diabetic mother--short- and not look for
long-term implications. Best Pract Res Clin Obstet Gynaecol. 2015 Feb;29(2):256–69.
ACOG Practice Bulletin, Pregestational DM, Number 201: 2018
Neonatal Hypoglycemia:
“Chronic” antepartum-associated issues
1. Infants of diabetic mothers can demonstrate increased insulin “Trifecta of
production/secretion (fetal hyperinsulinemia) in addition to increased Neonatal
peripheral glucose utilization Hypoglycemia”
2. Infants of diabetic mothers can demonstrate defects in their ability to
mobilize glycogen after birth
3. Infants of diabetic mothers can demonstrate a relative adrenal insufficiency
with decreased levels of catecholamines

u Infants of diabetic mothers and Large for gestational age infants are at a
higher risk for prolonged increased insulin production
u Well controlled antenatal blood sugars during gestation marked decrease the
chance of significate neonatal hypoglycemia

Sharma A, Davis A, Shekhawat PS. Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term
outcomes. Transl Pediatr. 2017 Oct;6(4):335-348.