Subclinical respiratory dysfunction in neonates born to diabetic mothers and its association with cord blood adipokines

BACKGROUND: Maternal diabetes disrupts fetal lung development. This study aimed to compare cord blood adipokines and neonatal respiratory function tests (RFTs) in healthy neonates of diabetic mothers versus controls. METHODS: This prospective cohort study involved term, healthy newborns born to diabetic mothers (NDM group, n = 37) and sex- and age-matched healthy controls (NHC group, n = 40). RFTs were performed at 48 h of life using tidal breath analysis (TBA). The assessed parameters included time to peak tidal expiratory flow (TPTEF), the ratio of TPTEF to total expiratory time (TPTEF/TE), the ratio of volume to peak expiratory flow to total expiratory volume (VPTEF/VE), reflecting early airway mechanics. Low respiratory function was defined as TPTEF/TE below 35%. Cord blood adipokines including leptin, ghrelin, and adiponectin levels were measured by ELISA. RESULTS: The NDM group exhibited lower TPTEF, TPTEF/TE, and VPTEF/VE ratio TBA parameters (p < .001 for all). Cord blood leptin levels were higher in the NDM group, while ghrelin and adiponectin levels were lower (p = .002, p < .001 and p < .001 respectively). Ghrelin levels were positively correlated with TPTEF (ρ = 0.231, p = .043), TPTEF/TE (ρ = 0.264, p = .020), and VPTEF/VE (ρ = 0.236, p = .038). Decision tree analysis identified ghrelin as the primary discriminator of low RFTs, with an accuracy of 74%. CONCLUSION: Clinically healthy term infants born to diabetic mothers exhibit measurable impairments in RFTs at birth, accompanied by altered cord blood adipokine profiles, suggesting a potential role for adipokines as early biomarkers of respiratory vulnerability.