Association between maternal blood lipids and neonatal hypoglycaemia in pregnancy with gestational diabetes mellitus: a cohort study

Abstract

Background: Gestational diabetes mellitus (GDM) prevalence is on the rise globally. Offspring of diabetic mothers face increased risk of neonatal hypoglycaemia (NH), and women with GDM have abnormal lipid profiles. However, there is no consensus on the link between maternal blood lipids and NH in infants from mothers with GDM. This study aimed to explore how maternal blood lipids affect NH.

Methods: A retrospective cohort study was conducted at the First Affiliated Hospital of Sun Yat-sen University. Information on participants' baseline characteristics and maternal metabolic profiles of glucose and lipids was collected. Significant variables from the univariate analysis were included in logistic regression, which was used to construct the predictive model for NH. A nomogram was constructed for visualizing the model and assessed using the area under the receiver operating characteristic (ROC) curve (AUC).

Results: Neonatal capillary blood glucose (CBG) decreased rapidly in the first hour after birth, increased gradually from the first to the second hour, and then remained stable. In the NH group, 86.11% (502/583) of hypoglycaemia cases occurred within the first two hours after birth. Multivariate logistic regression suggested that the lipid indices of maternal apoprotein B/apoprotein A1 (Apo-B/Apo-A1) (odds ratio (OR) = 1.36, 95% confidence intervals (CIs): 1.049-1.764, P = 0.02) and apoprotein E (Apo-E) (OR = 1.014, 95% CIs: 1.004-1.024, P = 0.004) were positively associated with NH in neonates from mothers with GDM. Triglycerides (TGs) (OR = 0.883, 95% CIs: 0.788-0.986, P = 0.028) were inversely associated with NH. Maternal glycated haemoglobin (HbA1c), age, twin pregnancy and caesarean delivery also had predictive value of NH. The AUC of the nomogram derived from these factors for the prediction model of NH was 0.657 (95% CIs: 0.630-0.684).

Conclusions: The present study revealed that the Apo-B/Apo-A1 and Apo-E levels were associated with an increased risk of NH. A nomogram was developed to forecast the risk of NH in babies born to mothers with GDM, incorporating maternal blood lipids, HbA1c, age, twin pregnancy, and caesarean section. The trajectory of glycaemia for neonates indicates the need for intensive CBG monitoring within 2 h of birth for neonates from mothers with GDM.

Keywords: Blood lipids; Gestational diabetes mellitus; Neonatal hypoglycaemia; Nomogram; Prediction model.

Fig. 1

Process of clinical data collection and selection

Fig. 2

Glycaemic variation in neonates born after GDM in the first 48 h after birth. The middle solid line and shaded areas are the mean value and 95% CIs of the CBG in each hour, respectively. The inset shows the variation of CBG in each minute of the first two hours of life. The grey dotted line represents the glucose level of 2.6 mmol/L

Fig. 3

Nomogram predicting the risk of NH in newborns of GDM mothers. Seven indicators, including age, twin pregnancy, mode of delivery, HbA1c, TG, Apo-E and Apo-B/Apo-A1, were enrolled in the prediction model. The predictor points of each variable are projected to the top points scale and summed; then, the total points corresponding to the bottom risk scale represent the probability of NH for neonates born to GDM women

Fig. 4

The AUC was calculated by ROC analysis to evaluate the discrimination ability of the nomogram. ROC, receiver operating characteristic; AUC, area under the ROC curve