Document Detail

Low neonatal blood glucose levels in cesarean-delivered term newborns at Khartoum Hospital, Sudan.
Jump to Full Text
MedLine Citation:
PMID:  24913607     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Glucose is the main source of energy for organ function in neonates. There are few published recent data on neonatal glucose levels during cesarean delivery.
METHODS: A case (cesarean delivery) -control (vaginal delivery) study was conducted at Khartoum Hospital Sudan to compare blood glucose levels of term newborns born after elective cesarean delivery with those born vaginally.
RESULTS: Cord blood glucose levels at delivery were significantly lower in women who had a cesarean delivery compared with those who delivered vaginally (99.8 +/- 20.6 vs. 106.8 +/- 11.1 mg/dl, P = 0.026), but there was no significant difference (97.8 +/- 16.7 vs. 102.1 +/- 9.6, P = 0.110) in newborn glucose levels at 2 hours after delivery between the groups. In linear regression, cesarean delivery (-6.475 mg/dl, P = 0.013) and maternal blood glucose levels at the time of delivery (+0.619 mg, P < 0.001) were significantly associated with mean cord glucose levels.
CONCLUSION: This study shows that cord blood glucose levels are significantly lower in cesarean-delivered neonates than vaginally-delivered neonates. In addition, cord blood glucose levels are significantly associated with cesarean delivery and maternal blood glucose levels at delivery.Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2011479878124993.
Authors:
Shahad M Hussein; Yasir Salih; Duria A Rayis; Jalal A Bilal; Ishag Adam
Related Documents :
12145167 - Islet hyperperfusion during prediabetic phase in oletf rats, a model of type 2 diabetes.
23550587 - Lactate study using umbilical cord blood: agreement between lactate pro hand-held devic...
1214507 - The effect of anaesthesia and surgery on lymph flow, protein and leucocyte concentratio...
24975587 - A correlation between severe haemolytic disease of the fetus and newborn and maternal a...
11741757 - C-reactive protein (crp), a comparison of pre- and post-mortem blood levels.
7163977 - Blood flow during pregnancy in the rat: ii. dynamics of and litter variability in uteri...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-9
Journal Detail:
Title:  Diagnostic pathology     Volume:  9     ISSN:  1746-1596     ISO Abbreviation:  Diagn Pathol     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-6-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101251558     Medline TA:  Diagn Pathol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  112     Citation Subset:  -    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Diagn Pathol
Journal ID (iso-abbrev): Diagn Pathol
ISSN: 1746-1596
Publisher: BioMed Central
Article Information
Download PDF
Copyright © 2014 Hussein et al.; licensee BioMed Central Ltd.
open-access:
Received Day: 24 Month: 3 Year: 2014
Accepted Day: 21 Month: 5 Year: 2014
collection publication date: Year: 2014
Electronic publication date: Day: 9 Month: 6 Year: 2014
Volume: 9First Page: 112 Last Page: 112
PubMed Id: 24913607
ID: 4064508
Publisher Id: 1746-1596-9-112
DOI: 10.1186/1746-1596-9-112

Low neonatal blood glucose levels in cesarean-delivered term newborns at Khartoum Hospital, Sudan
Shahad M Hussein1 Email: shahadhussein@hotmail.com
Yasir Salih1 Email: dryasirsalih@yahoo.ie
Duria A Rayis1 Email: duria11@hotmail.com
Jalal A Bilal2 Email: jalalbilal2000@gmail.com
Ishag Adam123 Email: ishagadam@hotmail.com
1Department of Obstetrics and Gynecology, University of Khartoum, Khartoum, Sudan
2College of Medicine, Qassim University, Buraydah, Kingdom, Saudi Arabia
3Faculty of Medicine, University of Khartoum, Khartoum, Sudan

Letter to the Editor

There has been a recent dramatic increase in the rate of cesarean delivery [1,2]. There are many fetal and perinatal complications of cesarean delivery e.g. obesity, allergies, metabolic disturbance, and lower blood glucose levels in the offspring [3-6].

There are few published recent data on neonatal glucose levels during cesarean delivery [6-8]. Glucose is the main source of energy for organ function in neonates. In particular, glucose is an exclusive source of energy for the function of the central nervous system in neonates [9]. The definition and management of neonatal hypoglycemia are controversial and there is no constant cut-off point for low levels of neonatal glucose [10].

A case–control study was conducted at Khartoum Hospital, Sudan during April to June 2012 to investigate glucose levels in neonates born to women who delivered by elective cesarean. Cases were women delivered by elective cesarean (before labor) and controls were consecutive vaginal deliveries. In both arms of the study, women were at term (37–41 completed weeks of gestation), newborns were ≥ 2500 g at birth, there was no history of fetal problems, and Apgar scores were 8 or higher at 1 and 5 minutes.

Newborns of mothers with any medical disorder, ante/intra-partum complications, newborns with signs suggestive of perinatal stress, and instrumental delivery, and those who required intensive resuscitation and care were excluded from both cases and controls.

Mothers who underwent cesarean delivery were fasting for at least 6 h before cesarean delivery. All vaginally-delivered infants were placed at the breast immediately after delivery. Every newborn had a venous cord blood sample obtained from the umbilical cord and another sample was taken 2 h later from a peripheral vein.

This study received ethical clearance from the Research Board of the Faculty of Medicine, University of Khartoum, Sudan.

After signing an informed consent, demographic data were collected using a pretested questionnaire. Then maternal blood glucose levels at delivery and at 2 hours after delivery, cord glucose levels at delivery and 2 hours after delivery were measured immediately after collection for whole blood glucose levels using the bedside device Accu-Chek™ Multiclix (Roche Diagnostics, Mannheim Germany). Start of feeding time, sex of the newborn, neonatal weight, Apgar score, duration of labor, time of mother’s fasting, time of starting feeding after delivery, and fluids during labor, were recorded and analyzed.

Data were analyzed using SPSS for windows. Means and proportions of the basic socio-demographic, clinical data and blood glucose levels were compared between women who delivered vaginally and those who had a cesarean delivery using the Student’s t-test and X2 test, respectively. Linear regression was performed where blood glucose levels (cord, neonatal) were the dependent variable, and other variables (maternal and perinatal) were the independent variables. P < 0.05 was considered significant.

The two groups (55 women in each arm) were well matched in their basic characteristics (Table 1). The time of fasting was significantly longer in women who delivered by cesarean than in those who delivered vaginally (8.4 ± 1.1) vs. 3.4 ± 1.4 hours, P < 0.001, Table 1).

There were no significant differences in maternal blood glucose levels at delivery and at 2 hours after delivery in the two groups of women. However, cord blood glucose levels were significantly lower in women who delivered by cesarean than in those who delivered vaginally (99.8 ± 20.6 vs. 106.8 ± 11.1 mg/dl, P = 0.026). There was no significant difference in neonatal blood glucose levels at 2 hours after delivery between women who delivered by cesarean and those who delivered vaginally (97.8 ± 16.7 vs. 102.1 ± 9.6, P = 0.110) (Table 2 and Figures 1 and 2).

In linear regression, the factors that were significantly associated with mean cord blood glucose levels were cesarean delivery (-6.475 mg/dl, P = 0.013) and maternal glucose at the time of delivery (+0.619 mg, P < 0.001, Table 3). The factors that were significantly associated with mean newborn blood glucose levels at 2 hours after delivery were cord blood glucose (+0.954 mg, P < 0.001) and maternal glucose at 2 hours after delivery (+0.161, P = 0.004, Table 4).

A similar finding was reported by Melkie and his colleagues who found that cord blood glucose levels were significantly higher in vaginally-delivered newborns than in cesarean-delivered newborns at delivery, with no significant difference at 2 hours after delivery [7]. Recently, cord blood glucose levels were reported to be lower in cesarean delivery than in vaginal delivery [6]. However, the change in blood glucose levels over the first 2 hours of life was significantly higher in cesarean delivery vs. vaginal delivery (glucose levels alone were not different between the two groups). Additionally, cord blood glucose levels significantly affected the change in blood glucose levels over the first 2 h after delivery [6]. Similarly, a previous study showed that cord blood glucose values were significantly higher than those of newborns delivered by cesarean. These findings suggest that stress results in release of catecholamines during vaginal delivery [11,12].

The duration of fasting had no significant association with mean maternal blood glucose levels at delivery and at 2 hours following delivery. Maternal blood glucose levels at delivery were significantly associated with maternal blood glucose levels at 2 hours after delivery (+852 mg, P < 0.001).

In vaginal delivery, there was no correlation between cord blood glucose levels and newborn blood glucose levels 2 hours after delivery (r = 0.257, P = 0.056) and the duration of labor (r = 0.238, P = 0.078).

During fetal life, cord blood glucose concentrations are correlated with maternal blood glucose concentrations [13]. Fasting time and the catecholamines released during vaginal delivery are possible mechanisms for this difference in blood glucose levels [6]. Interestingly, in the current study, although maternal blood glucose levels were not different between women who delivered vaginally and those who delivered by cesarean, both cord blood glucose and newborn blood glucose levels 2 hours after delivery were associated with maternal blood glucose levels. Furthermore, in spite of a longer fasting time in women who delivered by cesarean than in those who delivered vaginally, fasting time was not significantly associated with maternal blood glucose levels. Therefore, newborn blood glucose was correlated with maternal blood glucose, which was not correlated with fasting time, which was assumed to be the more plausible explanation before [6].

In the current study, there was no correlation between blood glucose levels and the duration of labor in women who delivered vaginally. The stress of labor on the mother and newborn increases maternal and fetal catecholamines [14,15]. Catecholamine release is higher during normal vaginal delivery than during cesarean delivery [14]. This process forms an essential part of adaptation of the fetus to the extra-uterine environment [16].


Conclusions

In this study cord blood glucose levels are significantly lower in cesarean-delivered newborns than in vaginally-delivered newborns. In addition, cord blood glucose levels are significantly associated with cesarean delivery and maternal blood glucose levels at delivery.


Competing interest

The authors declare that they have no competing interests.


Authors’ contributions

SMH and IA designed the study. YS, JAB and DAR conducted the clinical work. IA, JAB and IA performed the statistical analyses. All of the authors read and approved the final manuscript.


References
Adam I,Epidemic /pandemic of Cesarean delivery: the scope of the problemInt J Health Sci (Qassim)Year: 2014 in press.
Abbaker AO,Abdullahi H,Rayis DA,Imam AM,Adam I,An Epidemic of Cesarean Deliveries at Khartoum Hospital in Sudan with Over Two-Fifths of Neonates Delivered through the AbdomenJ Women's Health Issues CareYear: 201396
Bråbäck L,Ekéus C,Lowe AJ,Hjern A,Confounding with familial determinants affects the association between mode of delivery and childhood asthma medication – a national cohort studyAllergy Asthma Clin ImmunolYear: 201391410.1186/1710-1492-9-1423590822
Atasay B,Ergun H,Okulu E,Mungan Akın I,Arsan S,The association between cord hormones and transient tachypnea of newborn in late preterm and term neonates who were delivered by cesarean sectionJ Matern Fetal Neonatal MedYear: 2013987788010.3109/14767058.2013.76584623311764
Li HT,Zhou YB,Liu JM,The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysisInt J Obes (Lond)Year: 2013989389910.1038/ijo.2012.19523207407
Marom R,Dollberg S,Mimouni FB,Berger I,Mordechayev N,Ochshorn Y,Mandel D,Neonatal blood glucose concentrations in caesarean and vaginally delivered term infantsActa PaediatrYear: 201091474147710.1111/j.1651-2227.2010.01865.x20528788
Melkie M,Yigeremu M,Nigussie P,Teka T,Kinde S,Is the difference in neonatal blood glucose concentration of caesarian and vaginally delivered term infants requiring separated reference intervals?BMC Research NotesYear: 2012951910.1186/1756-0500-5-51922999298
McGowan JE,Neonatal hypoglycemiaPediatr RevYear: 1999961510.1542/pir.20-7-e6
Inder T,How low can I go? The impact of hypoglycemia on the immature brainPediatricsYear: 2008944044110.1542/peds.2008-141718676561
Alkalay AL,Sarnat HB,Flores-Sarnat L,Elashoff JD,Farber SJ,Simmons CF,Population meta-analysis of low plasma glucose thresholds in full-term normal newbornsAm J PerinatolYear: 2006911511910.1055/s-2006-93191216506118
Lagercrantz H,Slotkin TA,The “stress” of being bornSci AmYear: 198691001073961465
Ha¨gnevik K,Faxelius G,Irestedt L,Lagercrantz H,Lundell B,Persson B,Catecholamine surge and metabolic adaptation in the newborn after vaginal delivery and caesarean sectionActa Paediatr ScandYear: 1984960260910.1111/j.1651-2227.1984.tb09982.x6485778
Cornblath M,Schwartz R,Cornblath M, Schwartz RFactors influencing glucose in the neonatesDisorders of carbohydrate metabolism in infancyYear: 19913Boston: Blackwell Scientific Publications58
Ronca AE,Abel RA,Ronan PJ,Renner KJ,Alberts JR,Effects of labor contractions on catecholamine release and breathing frequency in newborn ratsBehav NeurosciYear: 200691308131417201476
Lederman RP,McCann DS,Work B Jr,Huber MJ,Endogenous plasma epinephrine and norepinephrine in last-trimester pregnancy and laborAm J Obstet GynecolYear: 1977958900169
Ronca AE,Abel RA,Alberts JR,Perinatal stimulation and adaptation of the neonateActa PaediatrYear: 19969Suppl815

Figures

[Figure ID: F1]
Figure 1 

Cord blood glucose levels in vaginal and cesarean deliveries.



[Figure ID: F2]
Figure 2 

Newborn blood glucose levels at 2 hours after delivery in vaginal and cesarean deliveries.



Tables
[TableWrap ID: T1] Table 1 

Comparison of characteristics of women who delivered vaginally and by cesarean in Khartoum, Sudan


Variables
Vaginal delivery
Cesarean delivery
P
  (n = 55) (n = 55)  
The mean (SD) of
 
 
 
Age, years
28.2 (4.5)
29.0 (4.0)
0.323
parity
1.6 (1.4)
1.7 (1.3)
0.892
Gestational age, weeks
38.5 (1.0)
38.8 (1.0)
0.122
Body mass index, kg/cm2
28.1 (1.7)
28.3 (2.1)
0.725
Fasting time, hours
3.4 (1.4)
8.4 (1.1)
< 0.001
Number (percentage) of
 
 
 
Educational level ≤ secondary
28 (51.0)
24 (43.6)
0.276
Rural residence
11 (20.0)
11 (20.0)
0.549
Lack of antenatal care
1 (1.8)
1 (1.8)
0.752
Normal saline received
53 (96.4)
46 (83.6)
0.052
5% dextrose received 2 (3.6) 9 (16.4)  

[TableWrap ID: T2] Table 2 

Maternal and neonatal blood glucose levels in vaginal and cesarean deliveries in Khartoum, Sudan


Variables
Vaginal delivery
Cesarean delivery
P
  (n = 55) (n = 55)  
Maternal glucose at delivery, mg/dl
107.9 (14.6)
107.1 (17.0)
0.806
Maternal glucose 2 hours following delivery, mg/dl
101.5 (11.8)
103.4 (15.6)
0.450
Cord glucose, mg/dl
106.8 (11.1)
99.8 (20.6)
0.026
Infant blood glucose at 2 hours, mg/dl 102.1 (9.6) 97.8 (16.7) 0.110

[TableWrap ID: T3] Table 3 

Factors affecting cord blood glucose levels using multiple linear regressions


Variable Coefficient Standard error P-value
Maternal age
0.429
0.357
0.232
Parity
─ 1.017
1.128
0.369
Gestational age
─ 0.447
1.438
0.757
Body mass index
─ 0.904
─ 0.103
0.176
Cesarean delivery
─ 6.475
─ 0.194
0.013
Maternal glucose at delivery
0.619
0.590
< 0.001
Birth weight
6.370
6.411
0.323
Fetal gender 4.475 0.140 0.065

[TableWrap ID: T4] Table 4 

Factors affecting newborn blood glucose levels at 2 hours of age using multiple linear regressions


Variable Coefficient Standard error P-value
Maternal age
0.014
0.114
0.683
Parity
0.004
0.358
0.917
Gestational age
0.001
0.448
0.983
Body mass index
─ 0.017
0.206
0.541
Cesarean delivery
0.001
1.801
0.992
Maternal glucose at delivery
─ 0.105
0.055
0.101
Birth weight
0.043
2.020
0.165
Fetal gender
─ 0.050
0.791
0.081
Cord glucose
0.954
0.031
< 0.001
Maternal glucose at 2 hours
0.161
0.053
0.004
Time to start feeding
─ 0.016
0.074
0.591
Duration of maternal fasting 0.029 0.314 0.651


Article Categories:
  • Letter to the Editor

Keywords: Cord, Glucose, Cesarean delivery, Newborn, Sudan.

Previous Document:  Subcellular localization of calcium in the incompatible and compatible interactions of wheat and Puc...
Next Document:  The diagnostic accuracy of the MyDiagnostick to detect atrial fibrillation in primary care.