lncreased fetal catecholamines associated with postnatal hypoglycemic episodes: JAMA

Perinatal stress and fetal growth restriction are known risk factors for neonatal hypoglycemia, but the precise pathomechanism remains unclear. In a recent study, researchers investigated whether elevated catecholamine concentrations in umbilical cord blood (UCB) and amniotic fluid (AF) are associated with neonatal hypoglycemia and whether they correlate with postnatal glycemic levels. This study was published in the JAMA Pediatrics. The study was conducted by Henrike H. and colleagues.

The key findings of the study were:

• The study involved 328 neonates, with 234 in the risk group and 94 in the control group.

• Growth-restricted neonates showed increased umbilical cord blood (UCB) concentrations of norepinephrine (21.10 vs 10.88 nmol/L), metanephrine (0.37 vs 0.12 nmol/L), and 3-methoxytyramine (0.149 vs 0.091 nmol/L) compared to controls.

• Neonates with perinatal stress had increased UCB concentrations of norepinephrine (22.55 vs 10.88 nmol/L), normetanephrine (1.75 vs 1.25 nmol/L), and 3-methoxytyramine (0.120 vs 0.091 nmol/L).

• UCB norepinephrine, metanephrine, and 3-methoxytyramine concentrations were positively correlated with the number of hypoglycemic episodes (rs = 0.146, p = 0.01; rs = 0.151, p = 0.009; and rs = 0.180, p = 0.002, respectively).

• These concentrations were also negatively correlated with the lowest measured blood glucose levels (rs = -0.149, p = 0.01; and rs = -0.153, p = 0.008).

• UCB catecholamine concentrations were negatively correlated with amniotic fluid C-peptide concentration (rs = -0.212, p = 0.005; rs = -0.182, p = 0.016; and rs = -0.183, p = 0.016).

• A p-value of less than 0.0083 was considered statistically significant due to multiple comparisons.

Neonates at risk for hypoglycemia exhibited elevated catecholamine concentrations in UCB, which correlated with postnatal hypoglycemic episodes and lower blood glucose levels. These findings suggest a link between perinatal stress, fetal growth restriction, and neonatal hyperinsulinemic hypoglycemia. Understanding these mechanisms could improve the management of newborns at risk for hypoglycemia.

Reference:

Hoermann, H., van Faassen, M., Roeper, M., Hagenbeck, C., Herebian, D., Muller Kobold, A. C., Dukart, J., Kema, I. P., Mayatepek, E., Meissner, T., & Kummer, S. (2024). Association of fetal catecholamines with neonatal hypoglycemia. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2024.0304