Cord blood C-peptide level and neonatal outcome in relation to maternal Haemoglobin A1c in last trimester of pregnancy

Gestational diabetes mellitus occurs in 5-9% of pregnancies worldwide and is associated with a substantial increase in maternal and perinatal complications. It is a well known fact that tight glycemic control throughout the pregnancy can significantly reduce these complications. This can be achieved by a combination of diet control, exercise and pharmacological agents preferably insulin. Maternal control over the past 2-3 months can be assessed by measuring the glycated HBA1c levels. Poor glycemic control in the mother as shown by a high HBA1c level is associated with high insulin levels in the fetus and newborn, resulting in overgrowth and metabolic problems like hypoglycaemia, hyperbilirubinemia, hypocalcemia and hypomagnesemia. In recent years the proinsulin and C peptide has found rising attention as it is an independent marker of insulin biosynthesis and secretion, which makes it a special diagnostic tool in Diabetology and related fields. Cord blood serum C-peptide is the best marker for fetal insulin levels as it is much more stable than insulin in stored specimens. Fetal insulin level is a reflection of fetal and indirectly the maternal glycemic levels. We plan to study the relation between the level of C-peptide in cord blood of the newborn with neonatal outcome, in comparison with maternal HBA1c levels before delivery in diabetic pregnacies. This is a prospective study on 200 Omani diabetic pregnant women compared with 200 healthy pregnant women as controls. Cord blood C-peptide and glucose levels will be collected at the time of delivery. The results will be correlated with the perinatal outcome like neonatal anthropometric data, respiratory distress syndrome, hypoglycemia, hyperbilirubinemia and other metabolic disturbances like hypocalcemia and hypomagnesemia. The C-peptide levels will also be compared with maternal glycemic control as measured by the glycated HBA1c level before delivery. The results will help us to a better understanding of the effect of maternal glycemic control on the neonate and hopefully help in the better management and improved outcome of diabetic pregnancies in Oman.