Change of cortisol level in umbilical cord blood of neonates delivered by gestational diabetes mellitus mothers and its influence on offspring health

doi:10.3969/j.issn.1674-8115.2021.01.008

Abstract

Abstract: Objective

·To investigate the effect of gestational diabetes mellitus (GDM) on the cortisol level in neonatal umbilical cord blood, and explore the effects of high perinatal cortisol exposure on neonatal health status at preschool-period.

Methods

·A total of 170 mothers and their full-term neonates were selected, including 66 cases in GDM group and 104 cases in normal glucose tolerance (NGT) group. The umbilical cord blood from the newborns of the two groups was collected to measure the concentrations of cortisol and adrenocorticotropic hormone (ACTH). SPSS software was used to analyze the effect of GDM on cortisol and ACTH levels in the neonatal umbilical cord blood. Multiple linear regression model was used to analyze the influencing factors of cortisol level in the umbilical cord blood. Pearson χ² method was used to analyze the effects of perinatal high cortisol on the health status of offspring at preschool-period, and binary Logistic regression model was used to analyze the influencing factors of preschool-period obesity.

Results

·Compared with the NGT group, the cortisol level of neonatal umbilical cord blood in the GDM group was higher and ACTH level was lower (both P<0.05). Multiple linear regression analysis showed that maternal gestational times, and blood glucose at 1 h and 2 h after 75 g oral glucose tolerance test (OGTT) were the independent influencing factors of neonatal umbilical cord blood cortisol level (all P<0.05). The follow-up results showed that the offspring with higher perinatal cortisol level had higher pre-school obesity rate (P=0.009). Binary Logistic regression analysis confirmed that neonatal umbilical cord blood cortisol level ≥ 192.00 ng/mL was an independent risk factor of preschool-period obesity (OR=4.714, P=0.016).

Conclusion

·Maternal GDM can cause the increase of neonatal umbilical cord blood cortisol level. High perinatal cortisol exposure can increase the risk of preschool-period obesity in the offspring. GDM may cause long-term diseases in the offspring through perinatal high cortisol exposure.

Key words: gestational diabetes mellitus (GDM), umbilical cord blood, glucocorticoid, prenatal exposure delayed effect, obesity

CLC Number:

R714.256

Ya-jie ZHU, Hui LIN, Xi CHEN, Yi-ran ZHAO, Xin-mei LIU, He-feng HUANG. Change of cortisol level in umbilical cord blood of neonates delivered by gestational diabetes mellitus mothers and its influence on offspring health[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(1): 49-54.

Characteristic	NGT group (n=104)	GDM group (n=66)	P value
Mother
Age/year	30.42±2.97	31.79±3.67	0.008
Education/n (%)			0.348
High school or lower	34 (32.69)	29 (43.94)
Bachelor	55 (52.88)	31 (46.97)
Master or above	15 (14.42)	6 (9.09)
Pre-gestational weight/kg	54.61±6.79	56.73±7.53	0.058
Pre-gestational BMI/(kg·m^-2)	20.75±2.11	21.79±2.73	0.009
Weight gain during conception/kg	15.53±5.05	13.13±5.18	0.003
Pre-delivery weight/kg	70.15±7.77	69.86±8.32	0.816
Pre-delivery BMI/(kg·m^-2)	26.66±2.42	26.87±2.82	0.600
Height/cm	162.13±5.02	161.21±5.26	0.254
Gestational time/n (%)			0.407
1	43 (41.35)	25 (37.88)
2	31 (29.81)	26 (39.39)
≥3	30 (28.85)	15 (22.73)
Parity/n (%)			0.170
1	60 (57.69)	45 (68.18)
≥2	44 (42.31)	21 (31.82)
Neonate
Gestational age/week	38.89±0.70	38.90±0.71	0.865
Birth weight/g	3 400.67±306.82	3 455.00±366.34	0.316
Birth length/cm	50.01±0.51	50.16±0.57	0.070
Gender/n (%)			0.310
Male	54 (51.92)	29 (43.94)
Female	50 (48.08)	37 (56.06)

Characteristic	NGT group (n=104)	GDM group (n=66)	P value
Mother
Age/year	30.42±2.97	31.79±3.67	0.008
Education/n (%)			0.348
High school or lower	34 (32.69)	29 (43.94)
Bachelor	55 (52.88)	31 (46.97)
Master or above	15 (14.42)	6 (9.09)
Pre-gestational weight/kg	54.61±6.79	56.73±7.53	0.058
Pre-gestational BMI/(kg·m^-2)	20.75±2.11	21.79±2.73	0.009
Weight gain during conception/kg	15.53±5.05	13.13±5.18	0.003
Pre-delivery weight/kg	70.15±7.77	69.86±8.32	0.816
Pre-delivery BMI/(kg·m^-2)	26.66±2.42	26.87±2.82	0.600
Height/cm	162.13±5.02	161.21±5.26	0.254
Gestational time/n (%)			0.407
1	43 (41.35)	25 (37.88)
2	31 (29.81)	26 (39.39)
≥3	30 (28.85)	15 (22.73)
Parity/n (%)			0.170
1	60 (57.69)	45 (68.18)
≥2	44 (42.31)	21 (31.82)
Neonate
Gestational age/week	38.89±0.70	38.90±0.71	0.865
Birth weight/g	3 400.67±306.82	3 455.00±366.34	0.316
Birth length/cm	50.01±0.51	50.16±0.57	0.070
Gender/n (%)			0.310
Male	54 (51.92)	29 (43.94)
Female	50 (48.08)	37 (56.06)

Index	NGT group (n=104)	GDM group (n=66)
Fasting blood glucose/ (mmol·L^-1)	4.11±0.36	4.59±0.69
Blood glucose at 1 h after 75 g OGTT/(mmol·L^-1)	7.79±0.86	10.86±1.82
Blood glucose at 2 h after 75 g OGTT/(mmol·L^-1)	5.95±1.10	9.52±1.52

Index	NGT group (n=104)	GDM group (n=66)
Fasting blood glucose/ (mmol·L^-1)	4.11±0.36	4.59±0.69
Blood glucose at 1 h after 75 g OGTT/(mmol·L^-1)	7.79±0.86	10.86±1.82
Blood glucose at 2 h after 75 g OGTT/(mmol·L^-1)	5.95±1.10	9.52±1.52

Factor	Neonatal umbilical cord cortisol level
Factor	r value	P value
Mother
Age	0.042	0.590
Gestational time	0.183	0.021
Parity	0.131	0.099
Pre-gestational BMI	0.040	0.602
Pre-delivery BMI	0.019	0.803
Weight gain during conception	-0.041	0.605
Fasting blood glucose	0.029	0.714
Blood glucose at 1 h after 75 g OGTT	0.168	0.034
Blood glucose at 2 h after 75 g OGTT	0.168	0.033
Neonate
Gestational age	0.065	0.418
Birth weight	0.047	0.540

Change of cortisol level in umbilical cord blood of neonates delivered by gestational diabetes mellitus mothers and its influence on offspring health

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Factor	Neonatal umbilical cord cortisol level
Factor	β	95%CI	P value
Mode 1
Gestational time	6.960	0.077?13.843	0.048
Mode 2
Gestational time	6.814	0.132?13.212	0.048
Blood glucose at 1 h after 75 g OGTT	4.679	0.889?8.469	0.016
Mode 3
Gestational time	6.831	0.021?13.641	0.049
Blood glucose at 2 h after 75 g OGTT	3.749	0.244?7.254	0.036

Characteristic	Low cortisol level group (n=66)	High cortisol level group (n=66)	P value
Obesity/n (%)	5 (7.58)	16 (24.24)	0.009
Abnormal glucose metabolism/n (%)	1 (1.52)	0 （0）	0.315
Allergen sensitization/n (%)	5 (7.58)	7 (10.61)	0.545
Autism spectrum disorder/n (%)	0 （0）	0 （0）	-

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Factor	Offspring birth weight
Factor	β	95%CI	P value
Pre-delivery BMI	27.982	7.828?48.135	0.007
Neonatal gestational age	30.173	2.913?57.434	0.030
Neonatal umbilical cord blood cortisol level^①/(ng·mL^-1)
≤131.16	Ref	Ref	-
131.17?162.85	23.947	-118.160?166.054	0.740
162.86?198.52	24.072	-119.919?168.063	0.742
≥198.53	31.345	-111.935?174.625	0.666

Factor	Offspring birth weight
Factor	β	95%CI	P value
Pre-delivery BMI	27.982	7.828?48.135	0.007
Neonatal gestational age	30.173	2.913?57.434	0.030
Neonatal umbilical cord blood cortisol level^①/(ng·mL^-1)
≤131.16	Ref	Ref	-
131.17?162.85	23.947	-118.160?166.054	0.740
162.86?198.52	24.072	-119.919?168.063	0.742
≥198.53	31.345	-111.935?174.625	0.666

Factor	Preschool-period obesity in offspring
Factor	OR	95%CI	P value
Umbilical cord blood cortisol level^①/(ng·mL^-1)
≤133.82	Ref	Ref	-
133.83?163.01	0.233	0.021?2.151	0.196
163.02?191.99	0.732	0.154?3.532	0.690
≥192.00	4.714	1.342?16.572	0.016

Factor	Preschool-period obesity in offspring
Factor	OR	95%CI	P value
Umbilical cord blood cortisol level^①/(ng·mL^-1)
≤133.82	Ref	Ref	-
133.83?163.01	0.233	0.021?2.151	0.196
163.02?191.99	0.732	0.154?3.532	0.690
≥192.00	4.714	1.342?16.572	0.016