Background: Large for gestational age (LGA) is defined as a weight that lies above the 90^th percentile for that gestational age. Large babies are at risk of increased adverse maternal and neonatal outcomes. Neonatal complications include difficult deliveries, shoulder dystocia, plexus injuries, congenital anomalies etc. and various metabolic derangements – hypoglycemia, hyperbilirubinemia, hypocalcemia and polycythemia. The risk of hypoglycemia in LGA babies is independent of whether the mother has diabetes or not.

Aims and Objects: To determine the incidence and study the various risk factors of hypoglycaemia in LGA infants of non-diabetic mothers. Methodology: In this hospital based cross sectional descriptive study, LGA newborns delivered to non-diabetic mothers in Regional Institute of Medical Sciences (RIMS), Imphal and brought to the Department of Pediatrics, RIMS, Imphal were included in the study for blood glucose monitoring.

Results: A total of 106 LGA babies were studied during the period from 1^st October 2012 to 30^th September 2014. 16 (15.1%) babies were hypoglycaemic (<40mg/dl) during the first 24 hours of life. Of these, the incidence of hypoglycaemia at 2, 2-6 and 6-24 hours of life were found to be 8.5%, 3.8% and 2.8% respectively of the total hypoglycaemic cases. Hypoglycaemia was not observed in LGA babies born to mothers who were less than 20 years of age but significantly increased as mothers’ age progressed - 31.3% in 20-34 to 68.8% in more than 35 years age group (p=0.000). Babies born by LSCS operation had statistically significant hypoglycemia (p=0.041) as compared to assisted ventouse or normal deliveries. Increasing incidence of hypoglycemia occurred as the neonatal weight increased – from 8% in <4500 gm to 31% in 4500-5000 gm group (p=0.005). Babies with Apgar score <6 at 5 min was also at risk of hypoglycemia (p=0.001). No statistically significant co-relations were observed between hypoglycemia and period of gestation, parity and babies’ sex.

Keywords: LGA, newborns, LSCS, hypoglycaemia.

1. Hansen AR, Soul JS. Perinatal asphyxia. In : Cloherty JP, Eichenwald EC, Stark AR, editors. Manual of Neonatal care. 7^th New Delhi: Wolters Kluwer;2012. P 88-89.
2. Martinez A, Simmons R. Abnormalities of fetal growth. In :Taeusch HW, Ballard RA, Gleason CA, editors. Avery’s Diseases of The Newborn. 8th ed. Philadelphia: Elsevier Saunders 2005:32-45.
3. Onal EE, Hirfanoglu IM, Beken S, Altuntas N, Turkyilmaz C, Camyrdan AD, et a Are the neonatal ourcomes similar in large-for-gestational-age infants delivered by women with or without gestatioinal diabetes mellitus? World J Pediatr 2012 May 15; 8 (2): 136-139.
4. Boyd ME, Usher RH, McLean FH. Fetal macrosomia:prediction, risks, proposed Obst Gynecol 1983:61: 715-722.
5. Nassar AH, Usta IM, Khalil,AM, Melhem ZI, Naka TI, Musa AAA. Fetal Macrosomia (Z4500 g): Perinatal Outcome of 231 CasesAccording to the Mode of Delivery.Journal of Perinatology (2003) 23, 136–141
6. Bromwich P. Big babies. Br Med J 1986;293:1387–1388.
7. Williams AF. Hypoglycemia in newborns: a review. Bull. WHO. 1997; 75: 261-290
8. Gustafsson J. Neonatal energy substrate production. Indian J Med Res 2009 Nov;130 (5): 618-623.
9. Jain A, Aggarwal R, Sankar MJ, Agarwal R, Deorari AK,Paul VK. Hypoglycemia in the Newborn. 2014. Available at newbornwhocc.org. (Accessed on 10 August 2014)
10. Araz N, Araz M. Frequency of neonatal hypoglycaemia in large for gestational age infants of non-diabetic mother in community hospital. Acta Medica (Hradec Králové) 2006; 49 (4): 237–239.
11. Alkalay Arie L. Brain Imaging Findings in Neonatal Hypoglycemia: Case Report and Review of 23 Cases. Clinics of Pediatrics (Phila). 2005; 44(9): 783-790.
12. Straussman S, Levitsky LL. Neonatal hypoglycemia. Curr Opin Endocrinol Diabetes Obes 2010;17:20-24.
13. Schaefer-Graf UM, Rossi R, Bohrer C, Siebert G, Kjos SL, Dudenhausen JW, et al. Rate and risk factors of hypoglycaemia in Large-for-gestational-age newborn infants of non diabetic mothers. Am J Obstet Gynecol 2002 Oct; 187 (4): 913-917.
14. Essel JK, Opai-TettehET. Macrosomia-maternal and fetal risk factors. S Afr Med J 1995 Jan; 85 (1): 43-46.
15. Bekdas M, Demircioğlu F, Göksügür SB, Ekici A, Kısmet E. A cross-sectional study of non-diabetic macrosomic infants. Sri Lanka J Child Health. 2013; 42(2): 76-80
16. Oral E, Cagdas A, Gezer A, Kaleli S, Aydinli K, Ocer F. Perinatal and maternal outcomes of  fetal macrosomia. Eur J Obstet Gynecol Reprod Biol   2001;99: 167-171.
17. Akin Y, Comert S, Turan C. Macrosomic newborns: a 3-year review. Turkish J Pediatr. 2010; 52: 378-383.
18. Linder N, Lahat Y,  Kogan A,  Fridman E et al. Macrosomic newborns of non-diabetic mothers: anthropometric measurements and neonatal complications. Arch Dis Child Fetal  Neonatal Ed Ed 2014 99:F353-F358

19 Akinbi HT, Gerdes SJ. Macrosomic infants of nondiabetic mothers and elevated C peptide  levels in cord blood. Journal of Pediatrics 1995; 127: 481-484.

Ch. Shyamsunder

Associate Professor,Department of Pediatrics,

Regional Institute of Medical Sciences, Imphal, India