Maternal glycemic profiles during pregnancy and predelivery correlate with neonatal glucose homeostasis and jaundice risk: a prospective cohort study

Abstract

Background: Maternal hyperglycemia has been linked to adverse neonatal outcomes, including increased risk of neonatal hypoglycemia due to the stress of adapting to extrauterine life and the sudden decrease in maternal glucose supply. The association between maternal blood glucose control and neonatal conditions is crucial for developing strategies to improve neonatal health and prevent complications. This study aims to explore the correlation between maternal blood glucose levels during pregnancy and predelivery and neonatal outcomes, specifically hypoglycemia and jaundice.

Methods: In this prospective cohort study, we enrolled 710 pregnant women from a population-based sample. Demographic and obstetric data were collected, and maternal glycemic indicators, including hemoglobin A1c (HbA1c), were assessed alongside neonatal birth outcomes. A generalized linear model was employed to analyze the impact of maternal blood glucose on neonatal glucose and bilirubin levels, with Pearson correlation coefficients used to quantify relationships. Multiple regression analysis was conducted to identify key determinants of neonatal hypoglycemia and jaundice associated with maternal glycemic status.

Results: Pregnant women with diabetes in pregnancy (DIP) exhibited higher fasting blood glucose (FBG), glycated albumin (GA), and HbA1c levels compared to those with normal glycemia (P<0.01), and their offspring had an increased risk of adverse birth outcomes, such as lower birth weight and a 1-minute Apgar score below 7 (P<0.01). A significant negative correlation was observed between maternal predelivery blood glucose levels and neonatal blood glucose levels at 0.5 hours after delivery (BGLU0.5) (P<0.01). Conversely, a positive association was found between maternal predelivery glucose levels and neonatal bilirubin levels on the second and third day after birth (TB2 and TB3) (P<0.05). Additionally, for every 1% increase in HbA1c and 1 mmol/L increase in 1-hour oral glucose tolerance test (OGTT-1H) results, there was a significant decrease in neonatal BGLU0.5 [95% confidence interval (CI): (-0.1505, -0.004214), (-0.1698, -0.02407)] and an increase in TB3 [95% CI: (0.05107, 0.1970), (0.007170, 0.1544)]. Only in cesarean section delivery, every 1 mmol/L increase in predelivery blood glucose levels corresponded to an increase in neonatal blood glucose levels at 1 hour after delivery (BGLU1) levels. As to natural delivery, bilirubin levels on the first day after birth (TB1) and TB3 exhibited significant correlation with GA in third trimester. Furthermore, we also found that cesarean section predisposes neonates to a higher risk of jaundice, while natural delivery tends to have a greater influence on fetal glucose levels.

Conclusions: Maternal blood glucose levels significantly influence neonatal blood glucose and bilirubin levels, thereby heightening the risk of hypoglycemia and jaundice in newborns. These findings highlight the critical need for stringent glycemic control in pregnant women with DIP.

Keywords: Diabetic pregnancy; glycemic management; neonatal hypoglycemia; neonatal jaundice; prospective study.

Figure 1

Flowchart of patients included, grouped, and lost to follow-up. GDMA, gestational diabetes mellitus in advance; PGDM, pre-gestational diabetes mellitus.