Independent Maternal and Neonatal Predictors of Hypoglycemia in the Immediate Postnatal Period: A Prospective Observational Cohort Study” | ||
| Annals of Neonatology | ||
| Articles in Press, Accepted Manuscript, Available Online from 07 November 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/anj.2025.427635.1122 | ||
| Authors | ||
| Nagwa M. sabry Mahmoud; Aya Rabie Mohamed* ; Madiha S. Abdallah | ||
| Department of Pediatrics, Faculty of Medicine, Minia University Minia, Egypt | ||
| Abstract | ||
| Background: Neonatal hypoglycemia is a common and potentially serious metabolic disorder that can result in permanent neurodevelopmental impairment. Although several maternal and neonatal characteristics are recognized as individual risk factors, the combined and independent contributions of these variables remain insufficiently defined in clinical settings. Understanding the interplay of such factors is essential to inform early screening, optimize resource use, and prevent adverse outcomes. Objective: To investigate the independent maternal and neonatal risk factors associated with the occurrence of neonatal hypoglycemia in the immediate postnatal period and to quantify their predictive strength using multivariate modeling. Methods: In this prospective observational cohort study, 100 neonates at high risk for hypoglycemia were enrolled within the first 24 hours of life at a tertiary neonatal intensive care unit. Risk factors assessed included intrauterine growth restriction (IUGR), infant of a diabetic mother (IDM), large for gestational age (LGA), gestational age, birth weight, mode of delivery, and maternal medical history. Blood glucose levels were measured via standardized capillary sampling at multiple time points during the first 12 hours of life. Logistic regression analysis was used to identify independent predictors of hypoglycemia, and model performance was evaluated using area under the receiver operating characteristic curve (AUROC) and the Hosmer–Lemeshow goodness-of-fit test. Results: Among the enrolled neonates, 38% developed hypoglycemia within the first 12 hours of life. IUGR (adjusted odds ratio [aOR] 3.52, 95% CI: 1.47–8.44), maternal diabetes (aOR 2.89, 95% CI: 1.19–7.02), and cesarean delivery (aOR 2.21, 95% CI: 1.01–4.89) were identified as significant independent predictors. Higher birth weight was found to be a protective factor (aOR 0.998 per gram, p = 0.031). The final multivariate model demonstrated good discriminative ability (AUROC = 0.79) and calibration (Hosmer–Lemeshow p = 0.62), indicating reliable predictive performance. Conclusion: The study confirms that specific maternal and neonatal factors—including IUGR, maternal diabetes, and mode of delivery—are strong independent predictors of neonatal hypoglycemia. These findings underscore the need for structured risk-based screening protocols to identify at-risk neonates early and allocate monitoring resources effectively. The validated predictive model may serve as a practical tool for clinicians to stratify hypoglycemia risk and guide early postnatal care. | ||
| Keywords | ||
| neonatal hypoglycemia; maternal risk factors; intrauterine growth restriction | ||
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