Iatrogenic Fetal Hypoglycemia Following Tight Peripartum Glucose Control in Diabetic Mothers: A Hypothesis and a Case Report

Abstract

Current management of diabetes in pregnancy includes prompt normalization of glucose prior to delivery in women with poorly controlled diabetes. While the benefits of glucose control throughout pregnancy are well-documented, the benefits of rapid glucose normalization prior to delivery are borderline. There is a lack of information on the fetal effects of this practice. There is a concern that a rapid decrease in maternal glucose level could cause hypoglycemia in the fetus, developing in the same manner as in a newborn infant of a mother with diabetes.

This case highlights a 37 week infant of a mother with poorly controlled diabetes, whose mother's glucose was normalized with intravenous insulin 24 hours before delivery. The infant's arterial cord blood glucose was 2.1 mmol/L, indicative of hypoglycemia, and it required neonatal intensive care unit admission. Current guidelines emphasize tight peripartum glycemic control but overlook potential fetal hypoglycemia before birth. This case suggests fetal hypoglycemia may precede neonatal hypoglycemia, with similar risks but limited diagnostic opportunities. Further research is needed to evaluate fetal outcomes of stringent glycemic control and to establish early cord blood glucose monitoring to improve the identification and management of hypoglycemia in this vulnerable population.

Keywords

cord blood glucose - fetal blood glucose - hypoglycemia - infant of diabetic mother - infant - newborn - peripartum period

Discloser

The author does not have any other affiliations outside of the University of Oklahoma Health Sciences Center.

Note

The author is the only author of the submitted manuscript.

Ethical approval

The collection of the patient's data was approved by the University of Oklahoma Health Sciences Center IRB, IRB #: 17488. The author was conforming to the Declaration of Helsinki.

Publikationsverlauf

Artikel online veröffentlicht:
11. April 2025

• References

• 1 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 201: pregestational diabetes mellitus. Obstet Gynecol 2018; 132 (06) e228-e248
• 2 Yamamoto JM, Benham J, Mohammad K, Donovan LE, Wood S. Intrapartum glycaemic control and neonatal hypoglycaemia in pregnancies complicated by diabetes: a systematic review. Diabet Med 2018; 35 (02) 173-183
• 3 Barrett HL, Morris J, McElduff A. Watchful waiting: a management protocol for maternal glycaemia in the peripartum period. Aust N Z J Obstet Gynaecol 2009; 49 (02) 162-167
• 4 Bitar G, Bravo R, Pedroza C. et al. Permissive intrapartum glucose control: an equivalence randomized control trial (PERMIT). Am J Obstet Gynecol 2024; 231 (03) 355.e1-355.e11
• 5 Wang Y, Liu H, Zhang L. et al. Umbilical artery cord blood glucose predicted hypoglycemia in gestational diabetes mellitus and other at-risk newborns. BMC Endocr Disord 2023; 23 (01) 277
• 6 Heck LJ, Erenberg A. Serum glucose levels in term neonates during the first 48 hours of life. J Pediatr 1987; 110 (01) 119-122
• 7 Worth C, Gokul PR, Ramsden K. et al. Brain magnetic resonance imaging review suggests unrecognised hypoglycaemia in childhood. Front Endocrinol (Lausanne) 2024; 15: 1338980