Neonatal Autonomic and Adrenocorticotropic Features in the Offspring of Mothers with Gestational Diabetes

Gestational diabetes mellitus (GDM) affects intrauterine glucose regulation and influences heart rate variability (HRV) and cortisol levels in newborns, which are markers of autonomic and hypothalamic-pituitary-adrenal axis function. This study aimed to evaluate HRV and cortisol levels in newborns of healthy mothers and those with GDM within the first 24 h of life, and to compare these measures between sexes.

A total of 59 newborns were monitored for heart rate (HR) and HRV from the 6 h of life. Salivary cortisol levels were measured 3-6 h (T1) and 20-24 h (T2) after birth. HRV parameters included the root mean square of successive differences (RMSSD), the high (HF) and low (LF) band power of HRV, and the LF/HF ratio.

GDM newborns showed lower HR, higher RMSSD, and a lower LF/HF ratio compared to controls. GDM females had lower HR than control females and GDM males, while GDM males had higher RMSSD and HF than control males. Cortisol levels decreased from T1-T2 in both groups with no sex differences.

Newborns from mothers with GDM exhibited lower HR and higher cardiac vagal modulation, with sex-specific differences. GDM females showed a decrease in HR without changes in HRV, whereas GDM males showed an increase in vagally mediated HRV without changes in HR. GDM does not seem to affect cortisol levels in newborns. These findings highlight sex-specific cardiac autonomic responses to birth stress in GDM-exposed newborns across the first day of life, which play an important role in shaping different behavioral, resilience, and well-being trajectories in early infancy.