What workup is needed at newborn assessment for an infant born to a mother with gestational diabetes (GD)?

From the Guidelines

Newborn infants born to mothers with gestational diabetes require careful monitoring of blood glucose levels, typically starting within 1-2 hours after birth and continuing every 2-4 hours before feedings until values stabilize, as recommended by recent guidelines 1. The workup should include a thorough physical examination focusing on signs of macrosomia, birth injuries, congenital anomalies, and respiratory distress. Assess for hypoglycemia symptoms including jitteriness, poor feeding, lethargy, apnea, seizures, and hypothermia. Early feeding within 1 hour of birth with breast milk or formula is recommended to prevent hypoglycemia, as supported by the standards of care in diabetes-2023 1. If hypoglycemia occurs and persists despite feeding, IV glucose (typically D10W at 2 mL/kg bolus followed by 4-8 mg/kg/min) may be necessary. Additional assessments should include evaluation for polycythemia, hypocalcemia, hypomagnesemia, and hyperbilirubinemia, as these conditions can be associated with gestational diabetes, according to the guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus 1. Cardiac evaluation may be warranted if there are concerns for hypertrophic cardiomyopathy, as maternal hyperglycemia can cause fetal hyperinsulinemia, leading to various metabolic disturbances after birth when the glucose supply from the mother is suddenly removed, as noted in the standards of medical care in diabetes-2020 1. Key points to consider in the workup include:

• Monitoring blood glucose levels closely after birth
• Early feeding to prevent hypoglycemia
• Evaluation for potential complications associated with gestational diabetes
• Consideration of cardiac evaluation if necessary These recommendations are based on the most recent and highest quality studies, including those from 2023 1, which prioritize the health and well-being of the newborn infant.

From the Research

Newborn Assessment for Infant Born to Mother with Gestational Diabetes

The workup needed at newborn assessment for an infant born to a mother with gestational diabetes (GD) includes:

• Monitoring for hypoglycemia, as it is a common complication in infants born to mothers with GD 2, 3, 4, 5
• Screening for respiratory distress syndrome, cardiomyopathy, polycythemia, and hyperviscosity, which can occur as a result of maternal hyperglycemia 2
• Checking for hypocalcemia and hypomagnesemia, which can also be present in infants born to mothers with GD 2
• Evaluating the infant's birth weight, as infants born to mothers with GD are at risk of being large-for-dates (LFD) or small-for-dates (SFD) 6
• Monitoring for birth asphyxia, which can occur in infants born to mothers with GD 6

Specific Tests and Monitoring

Specific tests and monitoring that may be needed include:

• Continuous glucose monitoring (CGM) to detect asymptomatic hypoglycemia 4
• Verification blood glucose (BG) using a point-of-care glucometer to confirm hypoglycemia 4
• Regular blood glucose checks to monitor for hypoglycemia 4, 5
• Monitoring for signs of respiratory distress, such as tachypnea, grunting, or retractions 2, 6

Risk Factors for Neonatal Hypoglycemia

Risk factors for neonatal hypoglycemia in infants born to mothers with GD include:

• Gestational weight gain (GWG) 5
• HbA1c at 1st trimester ≥5.2% 5
• HbA1c at GDM diagnosis 5
• Incidence of insulin therapy during pregnancy 5
• Maternal insulin therapy during pregnancy 5