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ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 1  |  Page : 12-15

Correlation of cord blood glycated hemoglobin with macrosomia and neonatal hypoglycemia in infants born to diabetic mothers


Department of Paediatrics, Father Muller Medical College Hospital, Mangalore, Karnataka, India

Date of Submission29-Jun-2020
Date of Acceptance03-Aug-2020
Date of Web Publication23-Dec-2020

Correspondence Address:
Dr. Habeeb Ullah Khan
Department of Paediatrics, Father Muller Medical College Hospital, Kankanady, Mangalore - 575 002, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjmsr.mjmsr_24_20

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  Abstract 


Background: Infants born to diabetic mothers are prone to hypoglycemia once transplacental supply of glucose is cut off due to which there is transient low blood glucose concentration during the first 2 h after delivery. Aim: Our study aimed at the correlation of cord blood glycated hemoglobin (HbA1c) with neonatal hypoglycemia and macrosomia in infants of diabetic mothers (IDMs). Methods: A descriptive longitudinal study was conducted on 100 consecutive IDMs with gestational age >34 weeks in a tertiary care hospital between November 2016 and December 2017, meeting the inclusion criteria. Infant and maternal details were recorded in a predesigned pro forma. Cord blood HbA1c in IDMs correlated with neonatal hypoglycemia and macrosomia. Results: Out of the 100 IDMs, 33 babies developed hypoglycemia. The mean cord blood HbA1c among hypoglycemic babies was 6.4% ± 0.9%, which was higher and statistically highly significant (P < 0.001) than babies who did not develop hypoglycemia. Most hypoglycemic events occurred at 30 min of postnatal life. The birth weight of IDMs correlated with cord blood HbA1c levels. Out of the 33 babies with hypoglycemia, 31 (94%) were macrosomic. Macrosomia increased the risk of hypoglycemia in IDMs (odds ratio: 78, 95% confidence interval: 16.4–379). Conclusion: Cord blood HbA1c showed a significant correlation with the risk of macrosomia and neonatal hypoglycemia.

Keywords: Blood glucose, cord blood glycated hemoglobin, hypoglycemia, infants of diabetic mother, macrosomia, neonatal hypoglycemia


How to cite this article:
John S, Khan HU, Devdas JM, Hegde P. Correlation of cord blood glycated hemoglobin with macrosomia and neonatal hypoglycemia in infants born to diabetic mothers. Muller J Med Sci Res 2020;11:12-5

How to cite this URL:
John S, Khan HU, Devdas JM, Hegde P. Correlation of cord blood glycated hemoglobin with macrosomia and neonatal hypoglycemia in infants born to diabetic mothers. Muller J Med Sci Res [serial online] 2020 [cited 2021 Sep 28];11:12-5. Available from: https://www.mjmsr.net/text.asp?2020/11/1/12/304588




  Introduction Top


Diabetes mellitus is a fast-growing global problem rising on the waves of increasing obesity and age with huge social, health, and economic consequences. India is the second-most populous country globally, and the rates of gestational diabetes mellitus (GDM) are estimated to be 10%–14.3%. According to the International Diabetes Federation 2017, one in seven births is affected by gestational diabetes globally.[1],[2] In India, the prevalence of GDM varies from 6% to 9% in rural and 12% to 21% in urban areas.[3],[4]

At birth, continuous transplacental supply of glucose is cut off due to which there is transient low blood glucose concentration during the first 2 h after delivery. As per a study done by Stanley and Rozance, a nadir of 40 mg/dL (2.2 mmol/L) is usually seen, which then gradually increases and stabilizes by 4–6 h of life.[5]

Cord blood glycated hemoglobin (HbA1c) levels reflect glycemic control in diabetic mothers and in turn can be used to predict the risk of neonatal hypoglycemia and macrosomia.[6]

Objectives

1. To study the correlation between cord blood HbA1c and neonatal hypoglycemia in infants of diabetic mothers (IDMs)

2. To study the relationship between cord blood HbA1c and macrosomia in the same group.


  Methods Top


Our study was a descriptive longitudinal study done in a tertiary care hospital. First 100 infants born to diabetic mothers (GDM, Type 1 and 2 diabetes) with gestational age >34 weeks, between November 1, 2016, and December 31, 2017, were included in this study after obtaining institutional ethical committee clearance. At admission, written informed consent was obtained from the mothers. Early preterm babies; intrauterine growth-restricted babies; babies with meconium aspiration syndrome, sepsis, birth asphyxia, and congenital anomalies; and those not consenting for the study or discharged within 72 h were excluded from the study. Infant and maternal details were recorded in a predesigned pro forma.

After delivery, cord blood was collected from the placental side and sent for the estimation of HbA1c. Cord blood HbA1c levels were correlated with macrosomia and the development of neonatal hypoglycemia.

In the neonates, blood glucose was estimated by heel prick using a glucometer (glucose oxidase method, GlucoNavii GDH blood glucose meter, MFG: 2017.10.18, Serial No. M05E03AA1943 at 30 min and 1, 2, 3, 6, 12, 24, 48, and 72 h as per our hospital's neonatal intensive care unit protocol. Hypoglycemia detected by the glucometer was verified by a random blood glucose sample sent to the laboratory.

The operational definition for neonatal hypoglycemia is blood sugar level <40 mg/dL (2.2 mmol/L) irrespective of the gestational age or postnatal day.[7] Macrosomia is defined as infants with birth weight >4000 g irrespective of the gestational age.[8] The collected data were analyzed by mean, standard deviation, Chi-square test, analysis of variance for repeated measures, and Karl Pearson's correlation coefficient.


  Results Top


The first 100 IDMs (>34-week gestational age) born and admitted between November 1, 2016, and December 31, 2017, were included in our study. Out of the 100 mothers who had maternal diabetes, 93 had GDM and 7 had Type 2 diabetes mellitus. There were 30 mothers who were on insulin, 20 were on insulin and metformin, 16 were on metformin, while 34 were controlled by diet. Out of the 100 IDMs, 36 (36%) were male and 64 (64%) were female, 9 were late preterm (34–37 weeks), and 91 were term (>37 weeks).

The birth weight of the babies in our study ranged from 3.1 to 4.6 kg, with a mean of 3.9 ± 0.4 kg and cord blood HbA1c ranged from 4.1% to 6.9%, with a mean of 5.3% ± 0.9%.

Cord blood glycated hemoglobin and birth weight

Birth weight of IDMs correlated with cord blood HbA1c levels, and this finding was statistically highly significant with P < 0.001 [Figure 1].
Figure 1: Cord blood glycated hemoglobin and birth weight

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Cord blood glycated hemoglobin and neonatal hypoglycemia

Out of the 100 IDMs, 33 babies developed hypoglycemia. The mean cord blood HbA1c among hypoglycemic babies was 6.4% ± 0.9%, whereas it was 4.8% ± 0.2% among nonhypoglycemic babies, which was again statistically highly significant with P < 0.001 [Table 1].
Table 1: Cord blood glycated hemoglobin and neonatal hypoglycemia

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Macrosomia and neonatal hypoglycemia

Out of the 100 IDMs in our study, 42 had birth weight above 4 kg, 40 had birth weight between 3.5 and 4 kg, and 18 babies had birth weight below 3.5 kg. Among the 33 babies who developed hypoglycemia, 31 (94%) were macrosomic. Macrosomia increased the risk of hypoglycemia in IDMs, and it was statistically significant with P < 0.001 (odds ratio: 78, 95% confidence interval: 16.4–379) [Table 2].
Table 2: Macrosomia and neonatal hypoglycemia

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Blood glucose trend

In our cohort, most of the hypoglycemic episodes occurred at 30 min (25 babies). The mean blood sugar levels at various time intervals after birth showed a rising trend, as shown in [Figure 2].
Figure 2: Blood glucose trend – mean blood glucose levels

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  Discussion Top


Our study comprised 100 IDMs with gestational age >34 weeks, aimed at correlating cord blood HbA1c with macrosomia and neonatal hypoglycemia.

Cord blood HbA1c correlated with birth weight. The mean cord blood HbA1c in macrosomic babies was 6.2% ± 0.6% as compared to 4.7% ± 0.5% in nonmacrosomic babies [Figure 1]. Mahapatra and Raj in their study showed that cord blood HbA1c >6.5 helped in predicting macrosomia.[9] On the other hand, Sosenko et al. showed no correlation between cord blood HbA1c and birth weight.[6]

Hypoglycemia was observed in 33 babies, and the mean cord blood HbA1c in them was 6.4% ± 0.9%. Among the 33 hypoglycemic babies, cord blood HbA1c was above 6 in 32 babies. There was an association between high cord blood HbA1c and risk for hypoglycemia in the babies [Table 2]. Raj and Mahapatra, similarly, in their study showed that out of fifty IDMs, thirty developed hypoglycemia with a mean cord blood HbA1c of 6.4% ± 1%.[9] On the other hand, Meenakshi et al., in their study, included 87 diabetic mothers who had tight control of diabetes and their mean cord blood HbA1c was 4.6% ± 1.2%. Hypoglycemia was seen in 17 babies, and there was no correlation between cord blood HbA1c and hypoglycemia.[10]

In our cohort, most of the hypoglycemic episodes occurred at 30 min (25 babies). The mean blood sugar levels at various time intervals after birth subsequently showed a rising trend. In a study done by Stanley et al., blood glucose values reached a nadir of 55–60 mg/dL by 1–2 h of age. Thereafter, glucose levels showed a steady rise.[5]

Out of 42 macrosomic babies, 31 (74%) developed hypoglycemia, whereas only 3.5% of the nonmacrosomic babies developed hypoglycemia. This finding had a P < 0.001, which was statistically highly significant. Therefore, we can conclude that in our study, macrosomia was a significant risk for hypoglycemia [Table 1]. Agrawal et al. in their study showed that IDMs with hypoglycemia had significantly higher birth weight.[11] According to Das et al., there was significantly more hypoglycemia among IDMs with birth weight >4500 g compared to infants with birth weight <4500 g,[12] whereas Sosenko et al. found no association between macrosomia and hypoglycemia in IDMs.[6]


  Conclusion Top


Cord blood HbA1c showed a significant correlation with the risk of macrosomia and neonatal hypoglycemia. Macrosomia increased the risk of hypoglycemia.

Limitations

Our sample size was small. Future studies with larger sample size would be the way forward.

Acknowledgments

We would like to thank Dr. Sucharitha and Dr. Sudhir Prabhu for statistical analysis.

Financial support and sponsorship

This study was financially supported by Father Muller Medical College Hospital.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jiwani A, Marseille E, Lohse N, Damm P, Hod M, Kahn JG. Gestational diabetes mellitus: Results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med 2012;25:600-10.  Back to cited text no. 1
    
2.
International Diabetes Federation (IDF). IDF Diabetes Atlas 8th edition. 2017.  Back to cited text no. 2
    
3.
Verma A, Singh B, Mengi V. Gestational diabetes in rural women of Jammu. Indian J Community Med 2008;33:54-5.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, et al. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu)--a community based study. J Assoc Physicians India 2008;56:329-33.  Back to cited text no. 4
    
5.
Stanley CA, Rozance PJ, Thornton PS, De Leon DD, Harris D, Haymond MW, et al. Re-evaluating “transitional neonatal hypoglycemia”: Mechanism and implications for management. J Pediatr 2015;166:1520-50.  Back to cited text no. 5
    
6.
Sosenko JM, Kitzmiller JL, Fluckiger R. Umbilical cord glycosylated hemoglobin in infants of diabetic mothers: Relationships to neonatal hypoglycemia, macrosomia, and cord serum C-peptide. Diabetes Care 1982;5:566-70.  Back to cited text no. 6
    
7.
Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward-Platt MP, Schwartz R, et al. Controversies regarding definition of neonatal hypoglycemia: Suggested operational thresholds. Pediatrics 2000;105:1141-5.  Back to cited text no. 7
    
8.
Cloherty JP, Eichenwald EC, Hansen AR, Stark AR. Fetal assessment and prenatal diagnosis. In: Loise E, Heffner LJ, editors. Manual of neonatal care. 7th ed. Philadelphia: Wolters Kluwer Pvt Ltd; 2012. p. 5-6.  Back to cited text no. 8
    
9.
Mahapatra M, Raj R. Prediction of neonatal hypoglycemia using cord blood C-peptide and cord HbA1c in infant of diabetic mother. Indian J Basic Appl Med Res 2015;4:167-71.  Back to cited text no. 9
    
10.
Meenakshi G, Rohini D, Rachana S, Sameer P, Sheetal B, Anshul L. Umbilical cord blood glycosylated hemoglobin and C-peptide in infants of diabetic mothers and its correlation with neonatal hypoglycemia. Pjms 2014;4:29-31.  Back to cited text no. 10
    
11.
Agrawal RK, Lui K, Gupta JM. Neonatal hypoglycaemia in infants of diabetic mothers. J Paediatr Child Health 2000;36:354-6.  Back to cited text no. 11
    
12.
Das S, Irigoyen M, Patterson MB, Salvador A, Schutzman DL. Neonatal outcomes of macrosomic births in diabetic and non-diabetic women. Arch Dis Child Fetal Neonatal Ed. 2009;94:F419-22.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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