Maternal and fetal factors which influence cord blood glucose levels in term infants delivered by cesarean section

Aim: To assess factors contributing to cord venous glucose homeostasis in term infants delivered by elective cesarean section. Methods: Observational study of women-infant pairs at delivery. Biochemical and clinical data were collected about factors which might affect the levels of glucose, lactate, norepinephrine, epinephrine, cortisol, human growth hormone, glucagon, and insulin. Results: In the context of this data-set, three models explained a substantial amount regarding the variation: 79% of the variation in cord glucose levels is explained by levels of maternal glucose, cord venous pH, and cord lactate; 77% of the variation of cord lactate is explained by levels of cord venous pH, valine, maternal lactate and glucose, and cord norepinephrine; and 71% of the variation in cord norepinephrine is explained by levels of cord venous pO₂, maternal lactate, cord insulin, cord GABA (gamma-aminobutyric acid), cord lactate, cord epinephrine, cord norepinephrine sulfate, and cord valine. Conclusions: Term infants delivered by cesarean section are relatively hyperinsulinemic (insulin: glucose ratio of 2.4) and glucose levels are strongly associated with maternal glucose levels, cord pO₂, and lactate levels. There were no associations with levels of cord glucose and levels of cortisol, epinephrine and lactate, which have been shown to be important contributors to postnatal glucose homeostasis in some infant groups.