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Maternal obesity and degree of glucose intolerance on neonatal hypoglycaemia and birth weight: a retrospective observational cohort study in women with gestational diabetes mellitus

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Abstract

Gestational diabetes mellitus (GDM) is an increasing problem worldwide. Postnatal hypoglycaemia and excess foetal growth are known important metabolic complications of neonates born to women with diabetes. This retrospective cohort study aims to determine the influence of obesity and glucose intolerance on neonatal hypoglycaemia and birth weight over the 90th percentile (LGA). Data were abstracted from 303 patient medical records from singleton pregnancies diagnosed with GDM. Data were recorded during routine hospital visits. Demographic data were acquired by facilitated questionnaires and anthropometrics measured at the first antenatal appointment. Blood biochemical indices were recorded. Plasma glucose area under the curve (PG-AUC) was calculated from OGTT results as an index of glucose intolerance. OGTT results of 303 pregnant women aged between 33.6 years (29.8–37.7) diagnosed with GDM were described. Neonates of mothers with a BMI of over 30 kg/m2 were more likely to experience neonatal hypoglycaemia (24 (9.2%) vs. 23 (8.8%), p = 0.016) with odds ratio for neonatal hypoglycaemia significantly higher at 2.105, 95% CI (1.108, 4.00), p = 0.023. ROC analysis showed poor strength of association (0.587 (95% CI, .487 to .687). Neonatal LGA was neither associated with or predicted by PG-AUC nor obesity; however, multiparous women were 2.8 (95% CI (1.14, 6.78), p = 0.024) times more likely to have a baby born LGA.

Conclusion: Maternal obesity but not degree of glucose intolerance increased occurrence of neonatal hypoglycaemia. Multiparous women had greater risk of neonates born LGA.

What is Known:

•Excess foetal growth in utero has long-term metabolic implications which track into adulthood.

•Neonatal hypoglycaemia is detrimental to newborns in the acute phase with potential long-term implications on the central nervous system.

What is New:

•Maternal obesity but not degree of glucose intolerance in a GDM cohort increased occurrence of neonatal hypoglycaemia.

•Multiparous women diagnosed had greater risk of neonates born LGA.

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Abbreviations

APGAR:

Appearance, Pulse, Grimace, Activity, and Respiration

BMI:

Body mass index

CI:

Confidence interval

GDM:

Gestational diabetes mellitus

IADPSG:

International Association of the Diabetes and Pregnancy Study Groups

IQR:

Interquartile range

IRC:

Insulin-resistant condition

LGA:

Large for gestational age

NICU:

Neonatal Intensive Care Unit

OGTT:

Oral glucose tolerance test

PG-AUC:

Plasma glucose area under the curve

ROC:

Receiver operator characteristic

WHO:

World Health Organization

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Funding

This project was made possible by the University of Limerick via the EHS Deans scholarship (awarded to Alexandra Cremona) and the Health Research Institute (HRI) Strategic Research Fund (awarded to Prof. Clodagh O’Gorman).

Author information

Authors and Affiliations

  1. Health Research Institute (HRI), University of Limerick, Limerick, Ireland

    Alexandra Cremona, Jean Saunders, Amanda Cotter, Alan E. Donnelly & Clodagh S. O’Gorman

  2. School of Allied Health, University of Limerick, Limerick, Ireland

    Alexandra Cremona

  3. Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland

    Alexandra Cremona, Amanda Cotter, Alan E. Donnelly & Clodagh S. O’Gorman

  4. Institute of Nutrition & Dietetics (INDI), Dublin, Ireland

    Alexandra Cremona

  5. Physical Education and Sports Science (PESS), University of Limerick, Limerick, Ireland

    Alexandra Cremona & Alan E. Donnelly

  6. Statistics Consulting Unit (SCU/CSTAR @ UL), University of Limerick, Limerick, Ireland

    Jean Saunders

  7. University Maternity Hospital Limerick (UMHL), Limerick, Ireland

    Amanda Cotter

  8. The Division of Endocrinology, Department of Paediatrics, University of Toronto, Toronto, Canada

    Jill Hamilton

  9. Department of Paediatrics, University Hospital Limerick, Limerick, Ireland

    Clodagh S. O’Gorman

Authors
  1. Alexandra Cremona
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  2. Jean Saunders
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  3. Amanda Cotter
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  4. Jill Hamilton
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  5. Alan E. Donnelly
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  6. Clodagh S. O’Gorman
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Contributions

Alexandra Cremona designed the study, sought ethical approval, collected the data, performed data analysis, interpreted the study findings, wrote the manuscript and critically evaluated the manuscript. Jean Saunders supervised the data analysis. Clodagh O’Gorman, Jill Hamilton, Amanda Cotter and Alan Donnelly revised and critically evaluated the manuscript. All authors approved the final manuscript as submitted.

Corresponding author

Correspondence to Alexandra Cremona.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (HSE Mid-Western Regional Hospital Research Ethics Committee reference: 029/17) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Communicated by Peter de Winter

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Cremona, A., Saunders, J., Cotter, A. et al. Maternal obesity and degree of glucose intolerance on neonatal hypoglycaemia and birth weight: a retrospective observational cohort study in women with gestational diabetes mellitus. Eur J Pediatr 179, 653–660 (2020). https://doi.org/10.1007/s00431-019-03554-x

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