Neonatal Hyperbilirubinemia in Babies Born to Hyperglycemic Mothers

Abstract

Background & Objectives: Gestational diabetes mellitus (GDM) alters the intrauterine metabolic environment, exposing the fetus to postnatal metabolic complications. Among these, neonatal hyperbilirubinemia and hypoglycemia represent the primary clinical challenges. This study evaluated the incidence, clinical spectrum, co-occurrence of hypoglycemia, and maternal onset-related determinants of neonatal hyperbilirubinemia in babies born to hyperglycemic mothers admitted to a tertiary care neonatal intensive care unit (NICU). Methods: A prospective hospital-based observational study was conducted in the NICUs attached to J.J.M. Medical College, Davangere, over an 18-month period (March 2021 to October 2022). A cohort of 105 neonates born to GDM mothers was evaluated. Data were gathered regarding maternal GDM onset (early [<24 weeks] vs. late [≥24 weeks]), neonatal clinical profiles, total serum bilirubin levels, and blood glucose levels. Results: The overall incidence of neonatal hyperbilirubinemia in infants of diabetic mothers (IDMs) was 43.8% (n = 46/105), while neonatal hypoglycemia was present in 64.8% (n = 68/105). Hyperbilirubinemia was observed in 35.0% (n = 7/20) of neonates born to mothers with early-onset GDM compared to 45.9% (n = 39/85) in those with late-onset GDM (p = 0.377). Hypoglycemia occurred in 75.0% (n = 15/20) of early-onset GDM infants compared to 62.4% (n = 53/85) in late-onset GDM infants (p = 0.287). The mean duration of NICU stay for affected neonates was 9.62 \pm 4.64 days. Conclusion: Neonatal hyperbilirubinemia and hypoglycemia affect a major proportion of GDM-exposed newborns. Although the timing of GDM onset did not yield a statistically significant difference in jaundice or hypoglycemia incidence, the strong metabolic interplay between fetal hyperinsulinemia, delayed hepatic enzyme maturation, and early glucose instability underscores the necessity of universal early bilirubin screening, glucose monitoring, and prompt enteral nutrition.