Maternal Lifestyle and Neonatal Hypoglycemia

Not Applicable

Completed

Conditions: Hyperinsulinemia
Sedentary Lifestyle
Hypoglycemia
Miscarriages
Pregnancy

Interventions: Behavioral: Daily brisk walking plus a carbohydrate-restricted diet

Brief Summary: tPA has a pivotal role in placentation, mediationg activation of growth factors, such as vascular endothelial growth factor and brain-derived neurotrophic factor, degradation of extracellular matrix and basement membrane (directly or through activation of matrix metalloproteinases) and formation of hemidesmosomes.

A high-carbohydrate intake combined with lack of physical activity provides a strong stimulus for maternal insulin production. In this scenario, either β-cells are dysfunctional and diabetes supervenes, or excessive amounts of insulin are produced, providing pathological stimulation of PAI-1 synthesis. Given that PAI-1 is a major tPA inhibitor, PAI-1 excess may affect placentation, increasing the risk of first trimester losses, preterm deliveries and intrauterine growth restriction.

Our hypothesis was that prematurity was not the cause of neonatal hypoglycemia, but a parallel occurrence of a strong stimulus for maternal, fetal and neonatal production of insulin.

Detailed Description: In an observational study, we sought to determine whether markers of hyperinsulinemia or situations that increase maternal insulin requirements would increase the risk of neonatal hypoglycemia. Mothers were selected if they had grade III obesity, acanthosis nigricans (surrogates of chronic maternal hyperinsulinemia), any invasive bacterial infection or if they had used corticosteroid within seven days before delivery (surrogates of subacute insulin resistance), if they reported to have consumed a high-glycemic index diet within 24 hours before delivery or if they were physically inactive within 24 hours before delivery (conditions that could increase maternal insulin requirements close to delivery).

Based on the finding that that the risk of neonatal hypoglycemia increased fivefold with inactivity (95% CI: 2-11, P \<0.001), 11-fold with high-carbohydrate intake (95% CI: 4-24, P \<0.001) and 329-fold with both risk factors (95% CI: 32-3362, P \<0.001), next we have evaluated how a protocol combining exercises and a balanced diet throughout pregnancy influences maternal and neonatal outcomes. One of the outcomes analyzed was neonatal hypoglycemia.

Recruitment & Eligibility

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Arm && Interventions

Group	Intervention	Description
Lifestyle counseling	Daily brisk walking plus a carbohydrate-restricted diet	Daily brisk walking plus a carbohydrate-restricted diet

Primary Outcome Measures

Name	Time	Method
Neonatal Hypoglycemia	1, 2 and 4 h after birth.	Any glucose level equal or below 40mg/dL at 1, 2 or 4 h after birth, obtained by heelstick.

Secondary Outcome Measures

Name	Time	Method
Refractory Hypoglycemia	One hour after feeding or after intravenous dextrose	Any glucose level ≤ 40/dL at 1, 2 or 4 h: 1. Neonates with hypoglycemia (glucose level equal or below 40 mg/dL at 1, 2 or 4 h) will be offered milk. Neonates unable to suckle, will be treated with intravenous dextrose for one hour. 2. A new heel stick blood sample will be drawn to assess glucose levels. 3. Neonates with persistent hypoglycemia will be considered as refractory hypoglycemia.