Polycythaemia in infants of diabetic mothers: β-hydroxybutyrate stimulates erythropoietic activity

Area of Science:

• Perinatal Medicine
• Endocrinology
• Neonatology

Background:

• Infants of diabetic mothers (IDMs) are at increased risk for polycythaemia.
• Intrauterine hyperinsulinaemia is a suspected cause of polycythaemia in IDMs.
• The role of maternal metabolic factors, such as beta-hydroxybutyrate (β-OHB), is less understood.

Purpose of the Study:

• To investigate the association between elevated maternal β-OHB levels and polycythaemia in infants of diabetic mothers.
• To explore whether β-OHB contributes to polycythaemia independently of intrauterine hyperinsulinaemia and erythropoietin.

Main Methods:

• Maternal glycosylated haemoglobin and β-OHB levels were measured in late gestation.
• Infant birth weight, cord blood insulin, fetal haemoglobin, and haematocrit were assessed.
• Infant venous blood samples were analyzed for haematocrit levels 4 hours post-delivery.

Main Results:

• Mothers with diabetes had significantly higher β-OHB and glycosylated haemoglobin levels.
• Infants of diabetic mothers exhibited higher birth weights, cord blood insulin, fetal haemoglobin, and haematocrit.
• A strong positive correlation was found between maternal β-OHB levels and infant polycythaemia.
• Cord blood erythropoietin levels were similar between groups.

Conclusions:

• Elevated maternal β-OHB is strongly correlated with polycythaemia in infants of diabetic mothers.
• β-OHB may independently stimulate erythropoiesis, contributing to polycythaemia pathogenesis.
• These findings highlight β-OHB as a potential key factor in polycythaemia development in IDMs.