Abstract
ObjectiveThe objective was to determine whether maternal nutritional factors are associated with transient neonatal hyperinsulinism (HI).Design and settingCase control study in 4 French tertiary Obstetrics and Neonatology Departments between 2008 and 2015.MethodsSixty-seven mothers of neonates diagnosed with transient hyperinsulinism and 113 mothers of controls were included. The screening for hyperinsulinemic hypoglycemia in neonates was performed because of clinical symptoms suggestive of hypoglycemia or in the presence of conventional risk factors (small-for-gestational-age, prematurity, anoxo-ischemia, hypothermia, macrosomia, gestational diabetes). Hyperinsulinemic hypoglycemia was confirmed in the HI neonates and ruled out in the controls. This allowed for comparing maternal nutrition in cases and controls in a context of similar risk factors. One to 2 mothers of control neonates were included per case, and a food frequency questionnaire was addressed to the mothers between day 5 and day 10 after the birth of their newborn.ResultsCrude odds ratio showed that maternal weight gain, abnormal fetal rate, C-section, gender, consumption of fresh cooked vegetables, fresh fruits and fruit juices, low fat diary products, light fat products, and daily bread were significantly associated with hyperinsulinism. Maternal body mass index, hypertension, gestational diabetes, birth weight percentile, gestational age and 5-minute Apgar score were not related to HI. In a multiple backward logistic regression model, consumption of fresh cooked vegetable ≥1/day (OR = 0.33 [0.14–0.77]) and light-fat products ≥1/week (OR = 0.24 [0.08–0.71]) was protective against hyperinsulinism, whereas gestational weight gain >20 kg (OR = 9.5 [2.0–45.5]) and between 15–20 kg (OR = 4.0 [1.2–14.0]), abnormal fetal heart rate (OR = 4.4 [1.6–12.0]), and C-section (OR = 3.4 [1.3–8.9]) were risk factors.ConclusionsA diet rich in fresh cooked vegetable and reduced in fat, together with the avoidance of a high gestational weight gain may be protective against transient neonatal hyperinsulinism.
Highlights
Neonatal hyperinsulinism (HI) is the first cause of recurrent neonatal hypoglycemia [1]
Risk factors for transient neonatal hyperinsulinism light fat products, and daily bread were significantly associated with hyperinsulinism
Hypertension, gestational diabetes, birth weight percentile, gestational age and 5-minute Apgar score were not related to HI
Summary
Neonatal hyperinsulinism (HI) is the first cause of recurrent neonatal hypoglycemia [1]. The incidence of minor and transient forms has been estimated to be 1/12000 births, four times more frequent than severe persistent forms, and this incidence is believed to be underestimated [3]. They usually recover spontaneously in several weeks [4]. The severity of neonatal HI results from neurological sequelae caused by neuroglycopenia and the associated suppression of lactates or ketone bodies, which cannot be used as alternative fuel to preserve neuronal function in the absence of glucose [2]. The outcome of transient HI was usually considered as benign compared to that of persistent HI,[4] some studies found that neurological consequences were similar in hypoglycemia due to transient and persistent neonatal HI [6, 7]
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