Role of umbilical cord C-peptide levels in early prediction
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Diabetes during pregnancy has been associated with a high risk of maternal, fetal, and neonatal morbidities and mortalities. The main aim of this study was to evaluate the risk factors of hypoglycemia in infants of diabetic mothers (IDMs) and to study the relationship between umbilical cord (UC) C peptide levels and the risk of developing hypoglycemia.

UC blood C-peptide and serial serum blood glucose measurements were done for all included singleton newborns born to diabetic mothers during the study period. Maternal and neonatal data such as gestational age, maternal age, maternal weight, types of diabetics and its control, maternal glycated hemoglobin (HbA1C), birth weight, Apgar score, and neonatal complete blood picture were collected.

In total, 83 IDMs met the inclusion criteria.

--54 developed hypoglycemia and 29 remained normoglycemic. However, there were no significant differences between hypoglycemic and normoglycemic IDMs in terms of types of maternal diabetics, & its duration.

--The hypoglycemia peak occurred within the first 3h of life, with 33.11±8.84 mg/dl for the hypoglycemia group and 54.10±6.66 mg/dl for the normoglycemic group.

--Most of the babies had no hypoglycemic manifestation (96.30%). Neonates with hypoglycemic mothers had poor diabetes control in the last trimester (HbA1C 7.09 ± 0.96%) compared to normoglycemic babies (HbA1C 6.11 ± 0.38%).

--The mean (SD) of UC C-peptide level in hypoglycemic neonates increased to 1.73 ± 1.07 ng/ml compared to normoglycemic ones with 1.08 ± 0.81 ng/ml.

In conclusion, poor control of diabetes, especially in the last trimester, is linked to neonatal hypoglycemia. Increased levels of UC C-peptide may be used as an initial warning on the higher risk of developing neonatal hypoglycemia.