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Impact of Maternal Glycated HemoglobinA1c Levels ≤6% and Race in Nondiabetic Pregnancies on Birthweight and Early Neonatal Hypoglycemia.

Authors
  • Kumar, Navin1
  • Kumar, Parkash2
  • Harris, Nathalee3
  • Monga, Ranjan3
  • Sampath, Venkatesh4
  • 1 Division of Neonatology, Hurley Children's Hospital, Flint, MI. Electronic address: [email protected]
  • 2 Department of Public Health, University of Michigan, Flint, MI.
  • 3 Division of Neonatology, Hurley Children's Hospital, Flint, MI.
  • 4 Division of Neonatology, Children's Mercy Hospital, Kansas City, MO.
Type
Published Article
Journal
The Journal of pediatrics
Publication Date
Aug 13, 2020
Identifiers
DOI: 10.1016/j.jpeds.2020.08.026
PMID: 32800816
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To evaluate whether pregnancy glycated hemoglobin (HbA1c) levels of ≤6% and maternal race impacts neonatal hypoglycemia and birthweight, and whether diabetes and beta blocker use during pregnancy additively impacts neonatal outcomes. Retrospective chart review of 4769 infants born at ≥34 weeks; 21 482 glucose measurements were assessed. Predefined groups were infants born to mothers without documented pregnancy conditions (group N), prenatal exposure of beta blockers (group B), diabetes (group D), or both (group DB). In group N, both in Caucasian (Caucasian, n = 1756; β = 2.6, P < .001) and African American (n = 1872; β = 2.2, P = .002) race, there was a direct relationship between pregnancy HbA1c levels and birthweight. HbA1c (aOR 1.8; 95% CI [1.3-2.5]) levels, maternal race, prematurity, cesarean delivery, and birth weight predicted hypoglycemia. Each 0.1% increase in HbA1c levels between 4.8 and 6 increased the odds of neonatal hypoglycemia by 6.4% in African American (β 0.62, SE 0.22, P = .01) and by 12.0% in Caucasian (β 1.13, SE 0.23 P < .001) population. The odds of neonatal hypoglycemia were 1.7 (group B), 2.1 (group D), and 3.1 (group DB) times higher compared with group N. Pregnancy HbA1c levels between 4.8% and 6.0% considered acceptable during pregnancy impacts neonatal hypoglycemia and birthweight especially in Caucasian race. A third trimester HbA1c >5.2 is a potential risk factor for neonatal hypoglycemia, especially in preterm infants. Although we report new findings on the relationship between maternal HbA1c levels and neonatal outcomes, a prospective study is required to validate our findings and determine "optimal" HbA1C levels during pregnancy. Copyright © 2020 Elsevier Inc. All rights reserved.

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