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May maternal lifestyle have an impact on neonatal glucose levels?
Silvia Hoirisch-Clapauch1, Maria Amelia S Porto2, Antonio E Nardi3
1High-Risk Maternal and Fetal Unit, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
Insights
Maternal lifestyle choices like inactivity and high-carb diets within 24 hours of delivery significantly increase the risk of neonatal hypoglycemia. These factors strongly influence fetal insulin production, leading to low blood sugar in newborns.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Maternal-Fetal Medicine
Background:
- Neonatal hypoglycemia is often linked to excessive fetal/neonatal insulin secretion.
- Hyperinsulinemia typically leads to large-for-gestational-age infants, but hypoglycemia in small infants suggests a peripartum stimulus.
- Maternal insulin stimulation near delivery may trigger fetal insulin production, causing neonatal hypoglycemia.
Purpose of the Study:
- To investigate maternal factors, particularly lifestyle, influencing neonatal hypoglycemia.
- To identify predictors of neonatal hypoglycemia in infants born to mothers with conditions affecting insulin regulation.
Main Methods:
- Evaluated 155 mothers and 158 neonates.
- Assessed maternal risk factors including obesity, infections, corticosteroid use, sedentariness, and high-carbohydrate intake.
- Monitored neonatal glycemic levels at 1, 2, and 4 hours post-birth.
- Correlated maternal parameters and neonatal minimum glucose levels with classical hypoglycemia predictors.
Main Results:
- Maternal sedentariness and high-carbohydrate intake within 24 hours of delivery were the sole independent predictors of neonatal hypoglycemia.
- Sedentariness increased hypoglycemia risk five-fold; high-carbohydrate intake increased it 11-fold.
- Combined sedentariness and high-carbohydrate intake elevated risk by 329-fold.
Conclusions:
- Maternal lifestyle in the 24 hours preceding delivery is a critical factor in neonatal hypoglycemia.
- Interventions focusing on maternal diet and physical activity near term may prevent neonatal hypoglycemia.
- Further controlled trials are warranted to confirm the efficacy of lifestyle modifications in preventing neonatal hypoglycemia.
Abstract:
Neonatal glucose levels correlate negatively with umbilical cord levels of C-peptide, a polypeptide secreted with insulin. In other words, neonatal hypoglycemia results from excessive insulin secretion from fetal/neonatal beta cells. Given that insulin causes fat to be stored rather than to be used for energy, one would expect that chronic hyperinsulinemia would result in large-for-gestational-age neonates. The finding that many small-for-gestational-age neonates have hypoglycemia suggests that the stimulus for insulin production occurs close to delivery. We postulated that a potent stimulation of maternal insulin production close to delivery would also provide a potent stimulus for fetal and neonatal insulin production, causing neonatal hypoglycemia. This study has evaluated 155 mothers with markers of excessive insulin production (such as acanthosis or grade III obesity), or with situations characterized by increased insulin requirements (such as an invasive bacterial infection or use of systemic corticosteroid within a week before delivery; or sedentariness or high-carbohydrate intake within 24h before delivery) and their 158 neonates who were screened for glycemic levels at 1, 2 and 4h after birth. The minimum glucose level was correlated to the maternal parameters, and to classical predictors of neonatal hypoglycemia, such as low-birth weight and preterm delivery. The only independent predictors were sedentariness and high-carbohydrate intake within 24h before delivery. The risk of neonatal hypoglycemia increased five-fold with sedentariness, 11-fold with high-carbohydrate intake, and 329-fold with both risk factors. The risk of neonatal hypoglycemia seems to be highly influenced by maternal lifestyle within 24h before delivery. Controlled randomized trials may help determine whether a controlled carbohydrate diet combined with regular physical activity close to delivery can prevent neonatal hypoglycemia and all its severe complications to the newborn.
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