(723) Does excess gestational weight gain increase the risk for neonatal hypoglycemia?

Neonatal hypoglycemia is a significant contributor to NICU admissions and prolonged hospitalization. Poorly controlled diabetes, preterm delivery, cesarean delivery, growth restriction, and maternal obesity, among other factors, have been shown to increase the risk. We hypothesized that excess gestational weight gain (GWG) is associated with increased rates of neonatal hypoglycemia.

Study Design:

We performed a retrospective cohort study of singleton, term deliveries in a single center between 1/1/2016 and 12/31/2021. The primary outcome was incidence of neonatal hypoglycemia in patients based on GWG. We used Institute of Medicine (IOM) guidelines based on pre-pregnancy BMI to determine category of GWG. Neonatal hypoglycemia was defined as a blood sugar < 40 (mg/dL). Secondary outcomes included rates of macrosomia and NICU admission by GWG category. Multivariable logistic regression was used to adjust for potential confounders (diabetes, macrosomia, and obesity).

Results: There were 23,902 term, singleton deliveries. Patients with excess GWG were more likely to be non-white, have undergone a CD (29 vs 22%, p< 0.001), have higher birthweight (3522 vs 3333g, p< 0.001), have a higher pre-pregnancy BMI (27 vs 26, p< 0.001) and less likely to be diabetic (8 vs 13%, P< 0.001) compared to patients with appropriate GWG. The odds of neonatal hypoglycemia were significantly higher for women with excess GWG (aOR 1.15, p=0.01). Odds of macrosomia and NICU admissions were also increased. Conversely, appropriate weight gain was protective against neonatal hypoglycemia (aOR 0.83, p=0.002).

Conclusion: These data suggest that independent of maternal BMI, macrosomia, or diabetes status, neonates of women with excess GWG are at increased risk of neonatal hypoglycemia. Although more research is needed to elucidate the pathophysiology and confirm these findings, these data suggest that counseling on GWG should address a potential increased risk of neonatal hypoglycemia at birth with excess GWG.