Drug-Induced Hypoglycemia in Neonates Born to Nondiabetic Women Treated with Medications during the Pregnancy or the Labor: A Systematic Review of the Literature

 

 Buy Article Permissions and Reprints

Abstract

The prompt identification of at-risk newborns for drug-induced hypoglycemia can minimize the risk for adverse side effects, inappropriate investigations, and considerable unnecessary costs. Existing literature discusses drug-induced hypoglycemia, but a systematic description of neonatal hypoglycemia induced or exacerbated by maternal medications is missing. We reviewed the association between neonatal hypoglycemia and maternal medications. We systematically searched the literature according to the PICOS model on drug-induced hypoglycemia in neonates born to nondiabetic women treated with medications during the pregnancy or the labor. The main outcomes of the review were: (1) prevalence of hypoglycemia, (2) risk factors and potential confounders, (3) time at onset and severity of hypoglycemia, (4) dose–response gradient, (5) metabolic features of hypoglycemia, (6) modalities to treat hypoglycemia, and (7) quality of the studies. We included 69 studies in this review and we identified 11 groups of maternal drugs related to neonatal hypoglycemia. Results were classified for each outcome. Our review aims at supporting clinicians in the identification of the newborn at risk for hypoglycemia and in the differential diagnosis of neonatal hypoglycemia. Further studies are necessary to assess the risk of neonatal hypoglycemia associated with common maternal medications.

Key Points

• A systematic description of neonatal hypoglycemia induced or exacerbated by maternal medications is missing.

• In our review we identified 11 groups of maternal drugs related to neonatal hypoglycemia.

• Our review aims at supporting clinicians in the identification of the newborn at risk for hypoglycemia.

Ethical Approval

The latest revision of the Helsinki Declaration as well as the Oviedo Declaration were the basis for the ethical conduct of the study. The study protocol was designed and conducted to ensure adherence to the principles and procedures of good clinical practice and to comply with the Italian laws. This research, based on previously published literature, did not meet criteria for local ethics committee approval.

Patient Consent

Written informed consents for publication of the clinical details were obtained from the parents of patient.

Authors' Contributions

E.M. and R.F. conceived, planned, and conceptualized the study. Two independent investigators (E.M. and R.F.) screened identified studies' titles and abstracts. Discrepancies were resolved by consensus or involving a third investigator (M.C.C.). G.P. and A.M. revised the manuscript. All authors approved the final version as submitted.

Publication History

Received: 01 August 2023

Accepted: 08 September 2023

Article published online:
17 October 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• References

• 1 Murad MH, Coto-Yglesias F, Wang AT. et al. Clinical review: drug-induced hypoglycemia: a systematic review. J Clin Endocrinol Metab 2009; 94 (03) 741-745
  CrossrefPubMedGoogle Scholar
• 2 Vue MH, Setter SM. Drug-induced glucose alterations part 1: drug-induced hypoglycemia. Diabetes Spectr 2011; 24 (03) 171-177
  CrossrefPubMedGoogle Scholar
• 3 Ng CL. Hypoglycaemia in nondiabetic patients - an evidence. Aust Fam Physician 2010; 39 (06) 399-404
  PubMedGoogle Scholar
• 4 Seltzer HS. Drug-induced hypoglycemia. A review based on 473 cases. Diabetes 1972; 21 (09) 955-966
  CrossrefPubMedGoogle Scholar
• 5 Ben Salem C, Fathallah N, Hmouda H, Bouraoui K. Drug-induced hypoglycaemia: an update. Drug Saf 2011; 34 (01) 21-45
  CrossrefPubMedGoogle Scholar
• 6 Chan JC, Cockram CS, Critchley JA. Drug-induced disorders of glucose metabolism. Mechanisms and management. Drug Saf 1996; 15 (02) 135-157
  CrossrefPubMedGoogle Scholar
• 7 Pandit MK, Burke J, Gustafson AB, Minocha A, Peiris AN. Drug-induced disorders of glucose tolerance. Ann Intern Med 1993; 118 (07) 529-539
  CrossrefPubMedGoogle Scholar
• 8 Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA 2003; 289 (13) 1652-1658
  CrossrefPubMedGoogle Scholar
• 9 Kristen Helms and Kristi Kelley. (2011). Drug-Induced Hypoglycemia, Hypoglycemia - Causes and Occurrences, Prof. Everlon Rigobelo (Ed.), ISBN: 978-953-307-657-7, InTech. Accessed December 22, 2022 at: http://www.intechopen.com/books/hypoglycemia-causes-and-occurrences/drug-induced-hypoglycemia
  PubMedGoogle Scholar
• 10 Maines E, Urru SAM, Leonardi L. et al. Drug-induced hyperinsulinemic hypoglycemia: an update on pathophysiology and treatment. Rev Endocr Metab Disord 2023; (e-pub ahead of print). DOI: 10.1007/s11154-023-09828-y.
  CrossrefPubMedGoogle Scholar
• 11 Ackley BJ, Swan BA, Ladwig G, Tucker S. (2008). Evidence-Based Nursing Care Guidelines: Medical-Surgical Interventions. (p. 7). St. Louis, MO: Mosby Elsevier;
  Google Scholar
• 12 Wang J, Cosci F. Neonatal withdrawal syndrome following late in utero exposure to selective serotonin reuptake inhibitors: a systematic review and meta-analysis of observational studies. Psychother Psychosom 2021; 90 (05) 299-307
  CrossrefPubMedGoogle Scholar
• 13 Nörby U, Forsberg L, Wide K, Sjörs G, Winbladh B, Källén K. Neonatal morbidity after maternal use of antidepressant drugs during pregnancy. Pediatrics 2016; 138 (05) e20160181
  CrossrefPubMedGoogle Scholar
• 14 Ferreira E, Carceller AM, Agogué C. et al. Effects of selective serotonin reuptake inhibitors and venlafaxine during pregnancy in term and preterm neonates. Pediatrics 2007; 119 (01) 52-59
  CrossrefPubMedGoogle Scholar
• 15 Costei AM, Kozer E, Ho T, Ito S, Koren G. Perinatal outcome following third trimester exposure to paroxetine. Arch Pediatr Adolesc Med 2002; 156 (11) 1129-1132
  CrossrefPubMedGoogle Scholar
• 16 Oberlander TF, Bonaguro RJ, Misri S, Papsdorf M, Ross CJ, Simpson EM. Infant serotonin transporter (SLC6A4) promoter genotype is associated with adverse neonatal outcomes after prenatal exposure to serotonin reuptake inhibitor medications. Mol Psychiatry 2008; 13 (01) 65-73
  CrossrefPubMedGoogle Scholar
• 17 Jordan AE, Jackson GL, Deardorff D, Shivakumar G, McIntire DD, Dashe JS. Serotonin reuptake inhibitor use in pregnancy and the neonatal behavioral syndrome. J Matern Fetal Neonatal Med 2008; 21 (10) 745-751
  CrossrefPubMedGoogle Scholar
• 18 Uguz F. The relationship between maternal antidepressants and neonatal hypoglycemia: a systematic review. Alpha Psychiatry 2021; 22 (05) 224-229
  CrossrefPubMedGoogle Scholar
• 19 Forsberg L, Navér L, Gustafsson LL, Wide K. Neonatal adaptation in infants prenatally exposed to antidepressants–clinical monitoring using Neonatal Abstinence Score. PLoS One 2014; 9 (11) e111327
  CrossrefPubMedGoogle Scholar
• 20 Källén B. Neonate characteristics after maternal use of antidepressants in late pregnancy. Arch Pediatr Adolesc Med 2004; 158 (04) 312-316
  CrossrefPubMedGoogle Scholar
• 21 Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med 2006; 160 (02) 173-176
  CrossrefPubMedGoogle Scholar
• 22 Lennestål R, Källén B. Delivery outcome in relation to maternal use of some recently introduced antidepressants. J Clin Psychopharmacol 2007; 27 (06) 607-613
  CrossrefPubMedGoogle Scholar
• 23 Shah J, Sarmiento K, Yang J, Shah PS. Maternal antidepressant use during pregnancy and neonatal hypoglycemia: prospective cohort study. J Perinatol 2020; 40 (07) 1025-1030
  CrossrefPubMedGoogle Scholar
• 24 Reis M, Källén B. Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data. Psychol Med 2010; 40 (10) 1723-1733
  CrossrefPubMedGoogle Scholar
• 25 Engelstad HJ, Roghair RD, Calarge CA, Colaizy TT, Stuart S, Haskell SE. Perinatal outcomes of pregnancies complicated by maternal depression with or without selective serotonin reuptake inhibitor therapy. Neonatology 2014; 105 (02) 149-154
  CrossrefPubMedGoogle Scholar
• 26 Källén B, Reis M. Neonatal complications after maternal concomitant use of SSRI and other central nervous system active drugs during the second or third trimester of pregnancy. J Clin Psychopharmacol 2012; 32 (05) 608-614
  CrossrefPubMedGoogle Scholar
• 27 Burdine J, Luedtke S. Serotonin toxicity versus withdrawal: clonidine one size fits all?. J Pediatr Pharmacol Ther 2021; 26 (05) 502-517
  PubMedGoogle Scholar
• 28 Razaz N, Tomson T, Wikström AK, Cnattingius S. Association between pregnancy and perinatal outcomes among women with epilepsy. JAMA Neurol 2017; 74 (08) 983-991
  CrossrefPubMedGoogle Scholar
• 29 Çoban D, Kurtoğlu S, Akın MA, Akçakuş M, Güneş T. Neonatal episodic hypoglycemia: a finding of valproic acid withdrawal. J Clin Res Pediatr Endocrinol 2010; 2 (02) 92-94
  CrossrefPubMedGoogle Scholar
• 30 Ebbesen F, Joergensen A, Hoseth E. et al. Neonatal hypoglycaemia and withdrawal symptoms after exposure in utero to valproate. Arch Dis Child Fetal Neonatal Ed 2000; 83 (02) F124-F129
  CrossrefPubMedGoogle Scholar
• 31 Thisted E, Ebbesen F. Malformations, withdrawal manifestations, and hypoglycaemia after exposure to valproate in utero. Arch Dis Child 1993; 69 (3 Spec No): 288-291
  CrossrefPubMedGoogle Scholar
• 32 Toksoy HB, Tanzer FN, Atalay A. Serum carnitine, beta-hydroxybutyrate and ammonia levels during valproic acid therapy. Turk J Pediatr 1995; 37 (01) 25-29
  PubMedGoogle Scholar
• 33 Thurston JH, Carroll JE, Dodson WE, Hauhart RE, Tasch V. Chronic valproate administration reduces fasting ketonemia in children. Neurology 1983; 33 (10) 1348-1350
  CrossrefPubMedGoogle Scholar
• 34 Hastie R, Tong S, Hiscock R. et al. Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study. BMC Med 2021; 19 (01) 291
  CrossrefPubMedGoogle Scholar
• 35 Bodén R, Lundgren M, Brandt L, Reutfors J, Andersen M, Kieler H. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. BMJ 2012; 345: e7085
  CrossrefPubMedGoogle Scholar
• 36 Pinelli JM, Symington AJ, Cunningham KA, Paes BA. Case report and review of the perinatal implications of maternal lithium use. Am J Obstet Gynecol 2002; 187 (01) 245-249
  CrossrefPubMedGoogle Scholar
• 37 Kozma C. Neonatal toxicity and transient neurodevelopmental deficits following prenatal exposure to lithium: another clinical report and a review of the literature. Am J Med Genet A 2005; 132A (04) 441-444
  CrossrefPubMedGoogle Scholar
• 38 Torfs M, Hompes T, Ceulemans M, Van Calsteren K, Vanhole C, Smits A. Early postnatal outcome and care after in utero exposure to lithium: a single center analysis of a Belgian Tertiary University Hospital. Int J Environ Res Public Health 2022; 19 (16) 10111
  CrossrefPubMedGoogle Scholar
• 39 Kuper SG, Baalbaki SH, Parrish MM, Jauk VC, Tita AT, Harper LM. Association between antenatal corticosteroids and neonatal hypoglycemia in indicated early preterm births. J Matern Fetal Neonatal Med 2018; 31 (23) 3095-3101
  CrossrefPubMedGoogle Scholar
• 40 Valencia G, Rojas V. Association between antenatal steroids for lung maturation and hypoglycaemia in the first 48 hours in premature infants between 26 and 34 weeks of gestational age. Pediatr Endocrinol Diabetes Metab 2019; 25 (04) 177-182
  CrossrefPubMedGoogle Scholar
• 41 di Pasquo E, Saccone G, Angeli L. et al. Determinants of neonatal hypoglycemia after antenatal administration of corticosteroids (ACS) for lung maturation: Data from two referral centers and review of the literature. Early Hum Dev 2020; 143: 104984
  CrossrefPubMedGoogle Scholar
• 42 Kim WJ, Han YS, Ko HS, Park IY, Shin JC, Wie JH. Antenatal corticosteroids and outcomes of preterm small-for-gestational-age neonates in a single medical center. Obstet Gynecol Sci 2018; 61 (01) 7-13
  CrossrefPubMedGoogle Scholar
• 43 Ben-David A, Zlatkin R, Bookstein-Peretz S, Meyer R, Mazaki-Tovi S, Yinon Y. Does antenatal steroids treatment in twin pregnancies prior to late preterm birth reduce neonatal morbidity? Evidence from a retrospective cohort study. Arch Gynecol Obstet 2020; 302 (05) 1121-1126
  CrossrefPubMedGoogle Scholar
• 44 Zipori Y, Zidan R, Lauterbach R. et al. Antenatal betamethasone and the risk of neonatal hypoglycemia: it's all about timing. Arch Gynecol Obstet 2021; 303 (03) 695-701
  CrossrefPubMedGoogle Scholar
• 45 Gupta K, Rajagopal R, King F, Simmons D. Complications of Antenatal Corticosteroids in Infants Born by Early Term Scheduled Cesarean Section. Diabetes Care 2020; 43 (04) 906-908 Erratum in: Diabetes Care. 2022;45(4):1025
  CrossrefPubMedGoogle Scholar
• 46 Gulersen M, Gyamfi-Bannerman C, Greenman M, Lenchner E, Rochelson B, Bornstein E. Time interval from late preterm antenatal corticosteroid administration to delivery and the impact on neonatal outcomes. Am J Obstet Gynecol MFM 2021; 3 (05) 100426
  CrossrefPubMedGoogle Scholar
• 47 Zigron R, Rotem R, Erlichman I. et al. Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: it's all about timing. Int J Gynaecol Obstet 2022; 158 (02) 385-389
  CrossrefPubMedGoogle Scholar
• 48 Dude AM, Yee LM, Henricks A, Eucalitto P, Badreldin N. Neonatal hypoglycemia after antenatal late preterm steroids in individuals with diabetes. J Perinatol 2021; 41 (12) 2749-2753
  CrossrefPubMedGoogle Scholar
• 49 Uquillas KR, Lee RH, Sardesai S. et al. Neonatal hypoglycemia after initiation of late preterm antenatal corticosteroids. J Perinatol 2020; 40 (09) 1339-1348
  CrossrefPubMedGoogle Scholar
• 50 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins - Obstetrics. Practice Bulletin No. 171: Management of preterm labor. Obstet Gynecol 2016; 128 (04) e155-e164
  CrossrefPubMedGoogle Scholar
• 51 Fowden AL, Vaughan OR, Murray AJ, Forhead AJ. Metabolic consequences of glucocorticoid exposure before birth. Nutrients 2022; 14 (11) 2304
  CrossrefPubMedGoogle Scholar
• 52 Sifianou P, Thanou V, Karga H. Metabolic and hormonal effects of antenatal betamethasone after 35 weeks of gestation. J Pediatr Pharmacol Ther 2015; 20 (02) 138-143
  PubMedGoogle Scholar
• 53 Badreldin N, Willert GG, Henricks AA, Peaceman A, Caldarelli LA, Yee LM. Implementation of an antenatal late-preterm corticosteroid protocol at a high-volume tertiary care center. Am J Obstet Gynecol MFM 2020; 2 (01) 100076
  CrossrefPubMedGoogle Scholar
• 54 Adamkin DH. Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011; 127 (03) 575-579
  CrossrefPubMedGoogle Scholar
• 55 Bateman BT, Patorno E, Desai RJ. et al. Late pregnancy β blocker exposure and risks of neonatal hypoglycemia and bradycardia. Pediatrics 2016; 138 (03) e20160731
  CrossrefPubMedGoogle Scholar
• 56 Cissoko H, Jonville-Béra AP, Swortfiguer D, Giraudeau B, Autret-Leca E. Exposition aux bêtabloquants en fin de grossesse. [Neonatal outcome after exposure to beta adrenergic blockers late in pregnancy] Arch Pediatr 2005; 12 (05) 543-547
  CrossrefPubMedGoogle Scholar
• 57 Kayser A, Beck E, Hoeltzenbein M. et al. Neonatal effects of intrauterine metoprolol/bisoprolol exposure during the second and third trimester: a cohort study with two comparison groups. J Hypertens 2020; 38 (02) 354-361
  CrossrefPubMedGoogle Scholar
• 58 Heida KY, Zeeman GG, Van Veen TR, Hulzebos CV. Neonatal side effects of maternal labetalol treatment in severe preeclampsia. Early Hum Dev 2012; 88 (07) 503-507
  CrossrefPubMedGoogle Scholar
• 59 Singhal S, Gupta AK. A comparative randomized controlled parallel group study of efficacy and tolerability of labetalol versus methyldopa in the treatment of mild preeclampsia. Int J Basic Clin Pharmacol 2017; 4 (03) 442-445
  PubMedGoogle Scholar
• 60 Easterling T, Mundle S, Bracken H. et al. Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial. Lancet 2019; 394 (10203): 1011-1021
  CrossrefPubMedGoogle Scholar
• 61 Kumar N, Kumar P, Harris N, Monga R, Sampath V. Impact of maternal HbA1c levels ≤6% and race in nondiabetic pregnancies on birthweight and early neonatal hypoglycemia. J Pediatr 2020; 227: 121-127.e3
  CrossrefPubMedGoogle Scholar
• 62 Mazkereth R, Maayan-Metzger A, Leibovitch L, Schushan-Eisen I, Morag I, Straus T. Short-term neonatal outcome among term infants after in-utero exposure to beta blockers. Isr Med Assoc J 2019; 21 (11) 724-727
  PubMedGoogle Scholar
• 63 Bigelow CA, Pan S, Overbey JR, Stone J. Propranolol for induction of labor in nulliparas trial a double-blind, randomized, placebo-controlled trial. Am J Obstet Gynecol MFM 2021; 3 (02) 100301
  CrossrefPubMedGoogle Scholar
• 64 Adauto DMB, Júnior IF, Macedo de Lima G. R Mauricio Barría, ed. Neonatal Hypoglycemia. Selected Topics in Neonatal Care. December 20, 2017
  PubMedGoogle Scholar
• 65 Guidance on the development of policies and guidelines for the prevention and management of hypoglycaemia of the newborn. 2013 . The Baby Friendly Initiative, UNICEF, United Kingdom. Accessed December 22, 2022 at: www.babyfriendly.org.uk
  PubMedGoogle Scholar
• 66 de Bruin R, van Dalen SL, Franx SJ. et al. The risk for neonatal hypoglycemia and bradycardia after beta-blocker use during pregnancy or lactation: a systematic review and meta-analysis. Int J Environ Res Public Health 2022; 19 (15) 9616
  CrossrefPubMedGoogle Scholar
• 67 Yada Y, Ohkuchi A, Otsuki K. et al; Survey Group Studying the Effects of Tocolytic Agents on Neonatal Adverse Events in Japan Society of Perinatal and Neonatal Medicine. Synergic interaction between ritodrine and magnesium sulfate on the occurrence of critical neonatal hyperkalemia: A Japanese nationwide retrospective cohort study. Sci Rep 2020; 10 (01) 7804
  CrossrefPubMedGoogle Scholar
• 68 Shimokawa S, Sakata A, Suga Y. et al. Incidence and risk factors of neonatal hypoglycemia after ritodrine therapy in premature labor: a retrospective cohort study. J Pharm Health Care Sci 2019; 5: 7
  CrossrefPubMedGoogle Scholar
• 69 Procianoy RS, Pinheiro CE. Neonatal hyperinsulinism after short-term maternal beta sympathomimetic therapy. J Pediatr 1982; 101 (04) 612-614
  CrossrefPubMedGoogle Scholar
• 70 Vigil-De Gracia P, Lasso M, Ruiz E, Vega-Malek JC, de Mena FT, López JC. or the HYLA treatment study. Severe hypertension in pregnancy: hydralazine or labetalol. A randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 2006; 128 (1-2): 157-162
  CrossrefPubMedGoogle Scholar
• 71 Epstein MF, Nicholls E, Stubblefield PG. Neonatal hypoglycemia after beta-sympathomimetic tocolytic therapy. J Pediatr 1979; 94 (03) 449-453
  CrossrefPubMedGoogle Scholar
• 72 Kurtoglu S, Akcakus M, Keskin M, Ozcan A, Hussain K. Severe hyperinsulinaemic hypoglycaemia in a baby born to a mother taking oral ritodrine therapy for preterm labour. Horm Res 2005; 64 (02) 61-63
  PubMedGoogle Scholar
• 73 Cottrill CM, McAllister Jr RG, Gettes L, Noonan JA. Propranolol therapy during pregnancy, labor, and delivery: evidence for transplacental drug transfer and impaired neonatal drug disposition. J Pediatr 1977; 91 (05) 812-814
  CrossrefPubMedGoogle Scholar
• 74 Thompson-Branch A, Havranek T. Neonatal hypoglycemia. Pediatr Rev 2017; 38 (04) 147-157
  CrossrefPubMedGoogle Scholar
• 75 Manganaro M, Papoff P, Cicchetti R, Caresta E, Moretti C. Hypoglycaemia in an infant with severe pulmonary hypertension after prenatal exposure to nimesulide: coincidence or side effect?. Acta Paediatr 2007; 96 (03) 475-477
  CrossrefPubMedGoogle Scholar
• 76 Niebyl JR, Witter FR. Neonatal outcome after indomethacin treatment for preterm labor. Am J Obstet Gynecol 1986; 155 (04) 747-749
  CrossrefPubMedGoogle Scholar
• 77 Dolitzky M, Inbal A, Segal Y, Weiss A, Brenner B, Carp H. A randomized study of thromboprophylaxis in women with unexplained consecutive recurrent miscarriages. Fertil Steril 2006; 86 (02) 362-366
  CrossrefPubMedGoogle Scholar
• 78 Turner G, Collins E. Fetal effects of regular salicylate ingestion in pregnancy. Lancet 1975; 2 (7930) 338-339
  CrossrefPubMedGoogle Scholar
• 79 Dani C, Perugi S, Fontanelli G. et al. Effects of epidural and systemic maternal analgesia in term infants: the NoPiL study. Front Biosci (Elite Ed) 2010; 2 (04) 1514-1519
  CrossrefPubMedGoogle Scholar
• 80 Swanström S, Bratteby LE. Metabolic effects of obstetric regional analgesia and of asphyxia in the newborn infant during the first two hours after birth. I. Arterial blood glucose concentrations. Acta Paediatr Scand 1981; 70 (06) 791-800
  CrossrefPubMedGoogle Scholar
• 81 Evron S, Glezerman M, Sadan O, Boaz M, Ezri T. Patient-controlled epidural analgesia for labor pain: effect on labor, delivery and neonatal outcome of 0.125% bupivacaine vs 0.2% ropivacaine. Int J Obstet Anesth 2004; 13 (01) 5-10
  CrossrefPubMedGoogle Scholar
• 82 Ding T, Deng CM, Shen XF. et al. Effect of a carbohydrate-rich beverage on rate of cesarean delivery in primigravidae with epidural labor analgesia: a multicenter randomized trial. BMC Pregnancy Childbirth 2022; 22 (01) 339
  CrossrefPubMedGoogle Scholar
• 83 Lai A, Philpot P, Boucher J, Meyer A. An outpatient methadone weaning program by a neonatal intensive care unit for neonatal abstinence syndrome. Popul Health Manag 2017; 20 (05) 397-401
  CrossrefPubMedGoogle Scholar
• 84 Bailey BA, Shah DS, Boynewicz KL, Justice NA, Wood DL. Impact of in utero opioid exposure on newborn outcomes: beyond neonatal opioid withdrawal syndrome. J Matern Fetal Neonatal Med 2022; 35 (25) 9383-9390
  CrossrefPubMedGoogle Scholar
• 85 Ogunyemi D, Friedman P, Betcher K. et al. Obstetrical correlates and perinatal consequences of neonatal hypoglycemia in term infants. J Matern Fetal Neonatal Med 2017; 30 (11) 1372-1377
  CrossrefPubMedGoogle Scholar
• 86 Thornton PS, Stanley CA, De Leon DD. et al; Pediatric Endocrine Society. Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. J Pediatr 2015; 167 (02) 238-245
  CrossrefPubMedGoogle Scholar
• 87 Hoermann H, Mokwa A, Roeper M. et al. Reliability and observer dependence of signs of neonatal hypoglycemia. J Pediatr 2022; 245: 22-29.e2
  CrossrefPubMedGoogle Scholar

• Supplementary Material