Authors (including presenting author) :
Siu YLC, Ng SW, Lo US, Pang SK, Sin WH, Ho LF, Leung PH
Affiliation :
Department of Obstetrics & Gynaecology, Princess Margaret Hospital
Introduction :
The incidence of gestational diabetes mellitus (GDM) is increasing worldwide. Infants born to diabetic mothers (IDMs) are at higher risk of hypoglycaemic attack. The current practice in our hospital is to transfer all IDMs to postnatal unit for formula feeding (FF) immediately after birth to prevent hypoglycemia. Nearly 10% of IDMs were separated for this reason according to our annual report from 2015 to 2017, which may potentially affect the successful establishment of breastfeeding (BF).
Objectives :
To explore the best choice of feeding for term IDMs by reviewing existing literatures and incorporating the best evidence to improve our patient care.
Methodology :
A review of literatures in English published from 1999 to 2019 was conducted by searching Ovid Medline, CINAHL, Cochrane Library, PubMed, Embase and hand search with the following keywords: Diabetes, Gestational, Hypoglycemia, Blood Glucose, skin-to-skin contact (SSC), Infant, Newborn, and Breastfeeding. Finally, 11 full-text articles were screened, and three articles which were the most relevant were included.
Result & Outcome :
A retrospective study comparing 134 IDMs with early BF and SSC to 148 with early FF revealed that the early BF group had a significantly lower hypoglycaemia rate and a significantly higher breastfeeding frequency in the early postpartum period. Thus, early BF was recommended as treatment for hypoglycaemia. Another retrospective study comparing 139 exclusive breastfed IDMs with SSC and 24 formula-fed IDMs showed no significant difference in glucose level between two groups, while the glucose level was found to be more stable in exclusive BF group. A retrospective cohort found that IDMs who received early BF (n=44) had a significant lower rate of hypoglycaemia compared to those who were not (n=40), suggesting that early BF may facilitate glycaemic stability in IDMs. Early BF together with immediate SSC had a significant lower incidence of neonatal hypoglycaemia. Therefore, it was recommended that healthy IDMs should stay with mothers, instead of transferred to postnatal for early AF.
