Study finds no hypoglycemia risk: Breastfeeding Safe for At-Risk Neonates Despite Lower Glucose Levels

A new study published in the Journal of Paediatrics and Child Health revealed that breastfed neonates showed overall lower glucose levels, yet hypoglycemia risk was similar across feeding groups, supporting breastfeeding as the preferred option. However long-term metabolic effects of early feeding practices require further study.

The prospective study from December 2019 to March 2020, examined how different feeding methods affect glucose regulation in neonates most vulnerable to hypoglycemia. These include babies born preterm, small or large for gestational age, and those born to mothers with diabetes or obesity.

In the hours immediately following birth, newborns naturally undergo a rapid adjustment in glucose control. Blood sugar levels decline before stabilising, and in some infants, this transition may trigger hypoglycemia, a condition where glucose drops too low and poses risks to brain development if unaddressed.

Early feeding is widely recommended to support this metabolic shift, but the role of breastfeeding versus formula feeding in influencing glucose patterns has remained unclear until now.

The Singapore study followed 192 at-risk neonates, tracking their blood glucose concentrations at 2, 6, 12, 18 and 24 hours after birth. This study compared infants who were exclusively breastfed with those exclusively formula-fed.

At 6, 12 and 24 hours of life, formula-fed infants consistently recorded higher glucose levels compared to breastfed infants. The difference was statistically significant, with formula-fed babies also showing a higher overall glucose exposure when researchers calculated the area under the curve (AUC) of blood sugar over time (85.1 vs. 80.5 mmol/L-hour).

Also, when hypoglycemia incidence was assessed, the results painted a different picture. Using the threshold of <3.0 mmol/L, the percentage of babies experiencing hypoglycemia was nearly the same between the groups, 14.7% in breastfed versus 11.1% in formula-fed infants. Even when a stricter cut-off of <2.6 mmol/L was applied, no major differences emerged.

Multivariable logistic regression, which adjusted for other potential risk factors, confirmed there was no significant association between feeding type and hypoglycemia risk. Overall, the findings suggest that while breastfed infants have slightly lower glucose levels, this does not translate into a higher risk of dangerous hypoglycemia.

Source:

Chan, D., Chandran, S., Chua, M. C., Zheng, R. T., & Yap, F. (2025). Breastfeeding and its impact on glucose trends and hypoglycaemia risk in at-risk neonates: A prospective observational study. Journal of Paediatrics and Child Health, jpc.70183. https://doi.org/10.1111/jpc.70183