Maternal Lifestyle and Neonatal Hypoglycemia
Maternal Lifestyle and Neonatal Hypoglycemia
tPA has a pivotal role in placentation, mediationg activation of growth factors, such as
 vascular endothelial growth factor and brain-derived neurotrophic factor, degradation of
 extracellular matrix and basement membrane (directly or through activation of matrix
 metalloproteinases) and formation of hemidesmosomes.

 A high-carbohydrate intake combined with lack of physical activity provides a strong stimulus
 for maternal insulin production. In this scenario, either β-cells are dysfunctional and
 diabetes supervenes, or excessive amounts of insulin are produced, providing pathological
 stimulation of PAI-1 synthesis. Given that PAI-1 is a major tPA inhibitor, PAI-1 excess may
 affect placentation, increasing the risk of first trimester losses, preterm deliveries and
 intrauterine growth restriction.

 Our hypothesis was that prematurity was not the cause of neonatal hypoglycemia, but a
 parallel occurrence of a strong stimulus for maternal, fetal and neonatal production of
 insulin.
In an observational study, we sought to determine whether markers of hyperinsulinemia or
 situations that increase maternal insulin requirements would increase the risk of neonatal
 hypoglycemia. Mothers were selected if they had grade III obesity, acanthosis nigricans
 (surrogates of chronic maternal hyperinsulinemia), any invasive bacterial infection or if
 they had used corticosteroid within seven days before delivery (surrogates of subacute
 insulin resistance), if they reported to have consumed a high-glycemic index diet within 24
 hours before delivery or if they were physically inactive within 24 hours before delivery
 (conditions that could increase maternal insulin requirements close to delivery).

 Based on the finding that that the risk of neonatal hypoglycemia increased fivefold with
 inactivity (95% CI: 2-11, P <0.001), 11-fold with high-carbohydrate intake (95% CI: 4-24, P
 <0.001) and 329-fold with both risk factors (95% CI: 32-3362, P <0.001), next we have
 evaluated how a protocol combining exercises and a balanced diet throughout pregnancy
 influences maternal and neonatal outcomes. One of the outcomes analyzed was neonatal
 hypoglycemia.
Inclusion criteria: recurrent early unexplained miscarriages Exclusion criteria: (i)
 antiphospholipid antibodies, (ii) second- or third-trimester losses, (iii) multiple
 pregnancy, (iv) anatomical abnormalities that could increase the risk of early
 miscarriages, (iv) any condition requiring a priori anticoagulation, (v) protocol
 violation.