The effects of perioperative fasting duration on neonatal hypoglycemia in caesarean delivery

The effects of perioperative fasting duration on neonatal hypoglycemia in caesarean delivery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effects of perioperative fasting duration on neonatal hypoglycemia in caesarean delivery Xirong Wu, Lin Mao, Xue Chen, Chunyu Zhu, Xiaoli Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9236114/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background To evaluate the relationship between preoperative fasting time and neonatal glucose levels and determine whether prolonged maternal fasting duration increased the difficulties of reversal of neonatal hypoglycemia. Methods This retrospective study included pregnant women who delivered by caesarean section from May 1, 2023 to May 1, 2024 and their neonates. Multivariable linear analyses were used to evaluate the association between fasting length and neonatal glucose values. Results When fasting length ≤ 7.6 hours, neonatal glucose levels in the 30 minutes of birth were negatively associated with the maternal fasting duration. When maternal fasting length of > 7.6 hours, obstetrical complications rather than maternal fasting time existed negative associations with neonatal glucose levels immediately at birth. Treatment with dextrose gel was still effective for reversal of neonatal hypoglycemia. Conclusion Maternal fasting time and obstetrical complications are required for appropriate preoperative management. Treatment with dextrose gel is still an effective intervention. caesarean delivery preoperative management neonatal outcomes Introduction Improved neonatal health is one of the major goals in China. Recently, concerns have been raised about the potential effect of caesarean delivery on the neonatal health given the widespread increase in the number of caesarean births. Some studies have shown that caesarean delivery is associated with significant metabolic changes such as lower levels of glucose in cord blood[ 1 , 2 ]. Before birth, the fetus receives glucose from its mother through facilitated diffusion across the placenta. Prolonged fasting before caesarean delivery results in the reduced glucose delivery to the fetus. The incidence rate of neonatal hypoglycemia in dogs was about 66% due to prolonged fasting and the fasting was considered risk factor for hypoglycemia[ 3 ]. A prospective cohort study revealed that maternal fasting time was associated with an increased risk of neonatal hypoglycemia[ 4 ]. However, the extent to which the fasting has contributed to this increase has not been evaluated. Besides, caesarean section without labor blunts the postnatal rise in cortisol and catecholamines, which are responsible for important energy metabolism[ 1 , 5 ]. Whether these changes are accompanied by the increased difficulties in treating neonatal hypoglycemia is still unknown. Therefore, in the current study, we aimed to further determine the association between fasting and neonatal hypoglycemia. And we also assessed whether treatment with 40% dextrose gel was still effective for reversal of neonatal hypoglycemia in long-term fasting babies. Methods We undertook this retrospective cohort study of pregnancies delivered at Affiliated hospital of Nantong University from May 1, 2023, and May 1, 2024. Inclusion criteria were singleton pregnancy, and gestational age ≥ 34 weeks for caesarean delivery. Women with multifetal gestation, and serious congenital malformation were excluded. This study was approved by the Ethics Committee of Affiliated hospital of Nantong University. Arterial blood gas samplings were collected from all neonates with the aim of obtaining blood glucose (BG) at 0 min of life. Neonates who were already recognized as being at risk of neonatal hypoglycemia were routinely screened in clinical practice. Risk factors were being the infant of a diabetic mother (gestational, type 1, type 2 diabetes), being preterm, being small (birthweight 4000g). Besides, blood glucose measurements were also performed in case of clinical symptoms. Neonatal hypoglycemia was defined as BG concentration of less than 2.6 mmol/L, which was the threshold for treatment used in our hospital. Subsequent treatment followed any hypoglycemia. If hypoglycemia persisted after two glucose interventions, neonates were admitted to NICU for further evaluation and treatment. Statistical analysis Data processing and statistical analyses were performed using SPSS version 27.0. Differences in baseline characteristics were compared using a t test or the Mann-Whitney U test for continuous data and the Chi-squared test for categorical data. The association between fasting length and glucose level was evaluated by multivariable linear analyses. For fasting length and glucose level, the following models were fitted: (i) ‘baseline model’, adjusting for age, type of anesthesia, parity, BMI, sex of neonates, the use of assisted reproductive technology, obstetrical and medical complications (including hypertensive disorders and thyroid disease); (ii) adjusted model, adjusted for all variables in baseline model plus risk factors of neonatal hypoglycemia. For fasting time, given the similar effect sizes of the associations between quartiles 2, 3, and 4 (Q2, Q3, and Q4) and neonatal hypoglycemia, these quartiles were combined. P < 0.05 was considered statistically significant. Results Characteristics of the study population A total of 858 women chose caesarean delivery at our hospital in the study period. Compared with those who fasted ≤ 7.6h, women fasting longer were older ( P = 0.016), and more likely to have reproductive history ( P < 0.001) and lower BMI ( P = 0.021). The rate of regional anesthesia was also higher in those who fasted longer ( P < 0.001). Other characteristics were similar in babies and their mothers. Additionally, risk factors for hypoglycemia were also similar in both groups (Table 1 ). Babies with shorter maternal fasting (≤ 7.6h) had significantly higher mean glucose concentrations in the 30 minutes of birth (Table 2 ). A significantly increased incidence of hypoglycemia in babies with longer maternal fasting status was only observed at birth (Table 2 )., showing that the treatment was timely and effective. Table 1 Baseline characteristics of participants based on their fasting length Maternal ≤ 7.6h (N = 212) > 7.6 h (N = 646) P Age (years) 30.42 ± 3.53 31.26 ± 4.26 0.016 Nulliparous (%) 170 (80.2%) 387 (59.9%) < 0.001 Postpregnancy BMI (kg/m 2 ) 28.76 ± 4.17 27.99 ± 3.74 0.021 Assisted reproductive technology 26 (12.3%) 72 (11.1%) 0.857 Hypertensive disorders of pregnancy 20 (9.5%) 51 (7.9%) 0.469 Thyroid disease 25 (11.8%) 70 (10.8%) 0.7 Anesthesia(Regional) 171 (80.7%) 583 (90.2%) < 0.001 Neonatal Boys 117 (55.2%) 320 (49.5%) 0.153 Apgar score of < 5 at 5 min 0 0 Risk factors for neonatal hypoglycaemia Late preterm 15 (7.1%) 29 (4.5%) 0.139 Infant of diabetic mother 60 (28.4%) 188 (29.1%) 0.407 birthweight 4000g 15 (7.1%) 61 (9.4%) Table 2 Frequency of neonatal hypoglycemia based on maternal fasting length a Glucose values immediately at birth were obtained from arterial blood gas; b Glucose values after birth were measured using heel-stick samplings. * P 7.6 h Glucose value Hypoglycemia % Glucose value Hypoglycemia % 0min a (n = 858) 4.165 ± 1.170 * 10 (4.7%) * 3.211 ± 0.579 * 71 (11%) * 30min b (n = 224) 3.905 ± 1.216 * 7 (12.1%) 3.082 ± 0.711 * 35 (21.1%) 60min b (n = 210) 3.378 ± 0.967 7 (21.9%) 3.055 ± 0.794 50 (28.1%) 90min b (n = 114) 3.508 ± 0.902 1 (8.3%) 3.443 ± 0.813 14 (13.7%) 120min b (n = 88) 3.814 ± 0.690 1 (7.1%) 3.893 ± 0.107 3 (4.1%) Admitted to NICU For hypoglycemia (n) 1 (0.5%) 6 (0.9%) Shorter fast length was associated with glucose levels within 30 min after birth Fast length of ≤ 7.6h was negatively associated with glucose levels in the baseline model ( P < 0.05) within 30 minutes after birth. Adjusting for risk factors for hypoglycemia reduced the β-estimate for the associations between fast length and glucose value but remained statistically significant ( P < 0.05). However, the negative association between fast length and glucose concentrations was lost after the 30 minutes of birth (Table 3 ). Table 3 β-estimate ± 95%CI for the association between fasting length and neonatal glucose values Baseline model Adjusted model Duration after birth Fasting length β (95%CI) P β (95%CI) P 0min ≤ 7.6h -0.245 (-0.318, -0.172) < 0.001 -0.232(-0.306, -0.158) 7.6 h -0.011(-0.029, 0.007) 0.222 -0.013 (-0.031, 0.004) 0.135 30min ≤ 7.6h -0.248(-0.395, -0.101) 0.001 -0.222(-0.377, -0.068) 0.006 > 7.6 h -0.017 (-0.066, 0.031) 0.48 -0.016 (-0.065, 0.033) 0.526 60min ≤ 7.6h -0.182 (-0.384, -0.020) 0.075 -0.189 (-0.459, 0.08) 0.157 > 7.6 h -0.019 (-0.039, 0.076) 0.519 0.011 (-0.047, 0.068) 0.714 90min ≤ 7.6h 0.062 (-0.684, 0.808) 0.808 0.585 (-0.879, 2.048) 0.124 > 7.6 h 0.016 (-0.064, 0.097) 0.688 0.02 (-0.065, 0.105) 0.641 120min ≤ 7.6h -0.091 (-0.513, 0.331) 0.582 -0.089 (-1.102, 0.923) 0.741 > 7.6 h -0.031 (-0.155, 0.093) 0.619 -0.04 (-0.171, 0.092) 0.547 Obstetrical, medical complications and neonatal hypoglycemia The impact of maternal complications on the identified associations was also evaluated by performing multiple linear regression analyses according to different fast lengths. BMI was positively associated with glucose values in neonates with maternal fast length of > 7.6h at birth ( P < 0.05 in the baseline and adjusted models). Medical or obstetrical complications including hypothyroidism and hypertensive disorders and the use of assisted reproductive technology (ART) were negatively associated with glucose values in prolonged fasting status at birth (Table 4 ). However, these significant associations were negated following the prompt treatment with hypoglycemia after birth. Table 4 β-estimate ± 95%CI for the association between neonatal glucose values immediately at birth and maternal complications when fasting time > 7.6 h Complications Baseline model Adjusted model β (95%CI) P β (95%CI) P BMI 0.015 (0.002, 0.028) 0.020 0.018 (0.005, 0.031) 0.007 ART -0.170 (-0.315, -0.025) 0.022 -0.17 (-0.314, -0.026) 0.021 Hypertensive disorders -0.14 (-0.316, 0.035) 0.117 -0.195 (-0.381, -0.009) 0.04 Hypothyroidism -0.154 (-0.307, -0.002) 0.047 -0.162 (-0.313, -0.01) 0.037 BMI=body mass index; ART= assisted reproductive technology Discussion Our findings showed that the neonatal hypoglycemia prevalence at birth was increased with the prolonged time of preoperative maternal fasting, and we also demonstrated negative associations between shorter maternal fasting length (≤ 7.6 hours) and neonatal blood glucose in the 30 minutes after birth. Following adjustment for risk factors for neonatal hypoglycemia, the strong negative associations remained between fasting length and neonatal blood glucose. Taken together our data supported the importance of the appropriate management of cesarean section such as preoperative maternal fasting length to reduce the chances of the babies being born with hypoglycemia. Previous studies have reported that the prevalence of neonatal hypoglycemia at birth exhibits fasting time-dependent increases[ 4 , 6 ]. We made detailed subgroup analyses in this study, which further revealed the association between fasting time and neonatal blood glucose after birth. Interestingly, we observed that this impact of maternal fasting length on neonatal blood glucose was lost when maternal fasting exceeded 7.6 hours. In this condition, some maternal complications appeared to a greater impact on neonatal blood glucose. This suggests that the metabolic abnormality during pregnancy potentially influences underling tissue mechanisms to physiology of fetal glucose homeostasis. Similar to well-known risk factors of neonatal hypoglycemia, gestational hypertension has also been demonstrated to be the risk factor of neonatal hypoglycemia[ 7 ]. Roshni Vamja et al (2024) proposed the relationship between maternal thyroid dysfunction and adverse neonatal outcomes, including neonatal hypoglycemia[ 8 ], which is consistent with our findings in this study. It’s worth to note that obesity may contribute to improve the neonatal blood glucose concentration after birth. Maternal BMI has been directly associated with neonatal birth weight[ 9 – 11 ]. Neonatal fat mass could provide glycogen stores when blood glucose concentrations decrease[ 12 ], which may partly explain why maternal BMI was positively associated with neonatal glucose values. Dextrose gel has been recommended to manage hypoglycemia for first-line treatment[ 13 ]. We observed that associations between maternal fasting time, Obstetrical, medical complications and neonatal blood levels were largely lost after gel administration. Prolonged maternal fasting time did not increase the difficulty of reversal of neonatal hypoglycemia. Conclusions In the present study, we demonstrated associations between maternal fasting time and neonatal blood concentrations. We further showed that treatment with dextrose gel is still effective and safe after long fasting time before delivery. Our findings highlight the adverse effects of inappropriate management of caesarean delivery and the effectiveness of dextrose gel administered orally. Maintaining appropriate obstetrical management could be a conventional way to reduce the occurrence of neonatal hypoglycemia. Abbreviations BG blood glucose BMI body mass index ART assisted reproductive technology Declarations Ethics approval and consent to participate: The study protocol was approved by the institutional review boards of affiliated hospital of Nantong university (NO: 2026-K015). Given the retrospective nature of the analysis, informed consent was waived by the Institutional Review Board. Consent for publication: Not applicable Competing Interests: The authors declare no competing interests. Fundings: This work has been supported by grants from the Open Project of Hainan Provincial Key Laboratory for Human Reproductive Medicine and Genetic Research (SZLAB202307), Nantong Municipal Health Commission (MS2023019) and Jiangsu Commission of Health (K2024033). Author Contribution Xirong Wu made substantial contributions to the design of the work and the analysis of data, Lin Mao drafted the work, Xue Chen and Chunyu Zhu collected the data, Xiaoli Sun revised this manuscript critically for important intellectual content, secured the funding and led the project. All authors approved the final version of the manuscript. Data Availability This study dataset related to the conclusions of the paper will be available to readers on request. Request to be sent to [email protected] . References Marchioro L, Shokry E, Geraghty AA, et al. Caesarean section, but not induction of labour, is associated with major changes in cord blood metabolome. Sci Rep. 2019;9(1):17562. Hyde MJ, Mostyn A, Modi N, et al. The health implications of birth by Caesarean section. Biol Rev Camb Philos Soc. 2012;87(1):229–43. Fuchs KDM, Pacífico KHN, Pereira GC, de Sousa, et al. Hypoglycaemia management with a hypercaloric supplementation in neonatal puppies delivered by caesarean section. Reprod Domest Anim. 2023;58(10):1345–51. Makino Y, Kiguchi T, Hayashi K, et al. Association between pregnant women fasting duration and neonatal hypoglycemia: A prospective cohort study. Int J Gynaecol Obstet. 2024;165(1):361–7. Hillman NH, Kallapur SG, Jobe AH. Physiology of transition from intrauterine to extrauterine life. Clin Perinatol. 2012;39(4):769–83. Arab S, Yaghmaei M, Mokhtari M. The Effect of Various Pre-Cesarean Fasting Times on Maternal and Neonatal Outcomes. Adv Biomed Res. 2022;11:104. Wang D, Zhou X, Ning J, et al. Risk factors for neonatal hypoglycemia: a meta-analysis. BMC Endocr Disord. 2024;24(1):166. Vamja R, Patel YMM, et al. Impact of maternal thyroid dysfunction on fetal and maternal outcomes in pregnancy: a prospective cohort study. Clin Diabetes Endocrinol. 2024;10(1):50. Gul R, Iqbal S, Anwar Z, et al. Pre-pregnancy maternal BMI as predictor of neonatal birth weight. PLoS ONE. 2020;15(10):e0240748. Sun Y, Shen Z, Zhan Y, et al. Effects of pre-pregnancy body mass index and gestational weight gain on maternal and infant complications. BMC Pregnancy Childbirth. 2020;20(1):390. Widen EM, Burns N, Kahn LG, et al. Prenatal weight and regional body composition trajectories and neonatal body composition: The NICHD Foetal Growth Studies. Pediatr Obes. 2023;18(3):e12994. Thompson-Branch A, Havranek T. Neonatal Hypoglycemia Pediatr Rev. 2017;38(4):147–57. Harris DL, Weston PJ, Signal M, et al. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet. 2013;382(9910):2077–83. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 06 May, 2026 Reviewers agreed at journal 29 Apr, 2026 Reviewers invited by journal 29 Apr, 2026 Editor assigned by journal 26 Apr, 2026 Editor invited by journal 06 Apr, 2026 Submission checks completed at journal 03 Apr, 2026 First submitted to journal 03 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9236114","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635729103,"identity":"9a62dd43-aa6a-4e56-b76d-1db6e4d7ccbb","order_by":0,"name":"Xirong Wu","email":"","orcid":"","institution":"Affiliated Hospital of Nantong University","correspondingAuthor":false,"prefix":"","firstName":"Xirong","middleName":"","lastName":"Wu","suffix":""},{"id":635729104,"identity":"51549dce-5bd7-44d1-a910-48180a289d1f","order_by":1,"name":"Lin Mao","email":"","orcid":"","institution":"QIDONG WOMEN’S AND CHILDREN’S HEALTH","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Mao","suffix":""},{"id":635729105,"identity":"58015573-ace5-4436-8b0e-d8e383609203","order_by":2,"name":"Xue Chen","email":"","orcid":"","institution":"Affiliated Hospital of Nantong University","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Chen","suffix":""},{"id":635729106,"identity":"aba1a145-1f60-41c6-815b-c9ff668d741a","order_by":3,"name":"Chunyu Zhu","email":"","orcid":"","institution":"Affiliated Hospital of Nantong University","correspondingAuthor":false,"prefix":"","firstName":"Chunyu","middleName":"","lastName":"Zhu","suffix":""},{"id":635729107,"identity":"66d15e95-aec9-4972-8f57-ac9329b155e3","order_by":4,"name":"Xiaoli Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIiWNgGAWjYNCCAhsefvYGkrQYpMlI9hwgTcthG4MbDkQqlp+RnfyZx+A8D8MNBsYPH3OI0MI4I3eb5AyD2zyMsxuYJWduI0ILs0TuNoYPQC3MMgfYmHmJ0cImkbv5Q4LBOR42iQQitfBI5G6Q+GBwgIeHaC0SPG9BfknmkeA52EycX+Tbczd/5qmws7c/3nzww0ditDAIJMBYjA3EqAcC/gNEKhwFo2AUjIKRCwCK+DFG9C75/wAAAABJRU5ErkJggg==","orcid":"","institution":"Affiliated Hospital of Nantong University","correspondingAuthor":true,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2026-03-26 15:40:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9236114/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9236114/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108806230,"identity":"0d8f7446-c836-4464-bfee-75f09df35df9","added_by":"auto","created_at":"2026-05-08 15:28:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":279931,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9236114/v1/36fee08b-4ddf-42a6-9b06-4bfb302f2d23.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effects of perioperative fasting duration on neonatal hypoglycemia in caesarean delivery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eImproved neonatal health is one of the major goals in China. Recently, concerns have been raised about the potential effect of caesarean delivery on the neonatal health given the widespread increase in the number of caesarean births. Some studies have shown that caesarean delivery is associated with significant metabolic changes such as lower levels of glucose in cord blood[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Before birth, the fetus receives glucose from its mother through facilitated diffusion across the placenta. Prolonged fasting before caesarean delivery results in the reduced glucose delivery to the fetus. The incidence rate of neonatal hypoglycemia in dogs was about 66% due to prolonged fasting and the fasting was considered risk factor for hypoglycemia[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A prospective cohort study revealed that maternal fasting time was associated with an increased risk of neonatal hypoglycemia[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, the extent to which the fasting has contributed to this increase has not been evaluated. Besides, caesarean section without labor blunts the postnatal rise in cortisol and catecholamines, which are responsible for important energy metabolism[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Whether these changes are accompanied by the increased difficulties in treating neonatal hypoglycemia is still unknown. Therefore, in the current study, we aimed to further determine the association between fasting and neonatal hypoglycemia. And we also assessed whether treatment with 40% dextrose gel was still effective for reversal of neonatal hypoglycemia in long-term fasting babies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe undertook this retrospective cohort study of pregnancies delivered at Affiliated hospital of Nantong University from May 1, 2023, and May 1, 2024. Inclusion criteria were singleton pregnancy, and gestational age\u0026thinsp;\u0026ge;\u0026thinsp;34 weeks for caesarean delivery. Women with multifetal gestation, and serious congenital malformation were excluded. This study was approved by the Ethics Committee of Affiliated hospital of Nantong University.\u003c/p\u003e \u003cp\u003eArterial blood gas samplings were collected from all neonates with the aim of obtaining blood glucose (BG) at 0 min of life. Neonates who were already recognized as being at risk of neonatal hypoglycemia were routinely screened in clinical practice. Risk factors were being the infant of a diabetic mother (gestational, type 1, type 2 diabetes), being preterm, being small (birthweight \u0026lt;\u0026thinsp;2500g) or large (birthweight \u0026gt;\u0026thinsp;4000g). Besides, blood glucose measurements were also performed in case of clinical symptoms.\u003c/p\u003e \u003cp\u003eNeonatal hypoglycemia was defined as BG concentration of less than 2.6 mmol/L, which was the threshold for treatment used in our hospital. Subsequent treatment followed any hypoglycemia. If hypoglycemia persisted after two glucose interventions, neonates were admitted to NICU for further evaluation and treatment.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData processing and statistical analyses were performed using SPSS version 27.0. Differences in baseline characteristics were compared using a \u003cem\u003et\u003c/em\u003e test or the Mann-Whitney U test for continuous data and the \u003cem\u003eChi-squared\u003c/em\u003e test for categorical data. The association between fasting length and glucose level was evaluated by multivariable linear analyses. For fasting length and glucose level, the following models were fitted: (i) \u0026lsquo;baseline model\u0026rsquo;, adjusting for age, type of anesthesia, parity, BMI, sex of neonates, the use of assisted reproductive technology, obstetrical and medical complications (including hypertensive disorders and thyroid disease); (ii) adjusted model, adjusted for all variables in baseline model plus risk factors of neonatal hypoglycemia. For fasting time, given the similar effect sizes of the associations between quartiles 2, 3, and 4 (Q2, Q3, and Q4) and neonatal hypoglycemia, these quartiles were combined. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the study population\u003c/h2\u003e \u003cp\u003eA total of 858 women chose caesarean delivery at our hospital in the study period. Compared with those who fasted\u0026thinsp;\u0026le;\u0026thinsp;7.6h, women fasting longer were older (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016), and more likely to have reproductive history (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and lower BMI (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021). The rate of regional anesthesia was also higher in those who fasted longer (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Other characteristics were similar in babies and their mothers. Additionally, risk factors for hypoglycemia were also similar in both groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Babies with shorter maternal fasting (\u0026le;\u0026thinsp;7.6h) had significantly higher mean glucose concentrations in the 30 minutes of birth (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A significantly increased incidence of hypoglycemia in babies with longer maternal fasting status was only observed at birth (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)., showing that the treatment was timely and effective.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of participants based on their fasting length\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMaternal\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7.6h (N\u0026thinsp;=\u0026thinsp;212)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7.6 h\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;646)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNulliparous (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170 (80.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e387 (59.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostpregnancy BMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.76\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.99\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssisted reproductive technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.857\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertensive disorders of pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia(Regional)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171 (80.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e583 (90.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeonatal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (55.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e320 (49.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApgar score of \u0026lt;\u0026thinsp;5 at 5 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk factors for neonatal hypoglycaemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLate preterm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfant of diabetic mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ebirthweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2500g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4000g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of neonatal hypoglycemia based on maternal fasting length \u003csup\u003ea\u003c/sup\u003e Glucose values immediately at birth were obtained from arterial blood gas; \u003csup\u003eb\u003c/sup\u003e Glucose values after birth were measured using heel-stick samplings. \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; NICU=neonatal intensive-care unit\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration after birth\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMaternal fasting time\u0026thinsp;\u0026le;\u0026thinsp;7.6h\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eMaternal fasting time\u0026thinsp;\u0026gt;\u0026thinsp;7.6 h\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGlucose value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eHypoglycemia %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eGlucose value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHypoglycemia %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0min\u003csup\u003ea\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;858)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.165\u0026thinsp;\u0026plusmn;\u0026thinsp;1.170 \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10 (4.7%) \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.211\u0026thinsp;\u0026plusmn;\u0026thinsp;0.579 \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e71 (11%) \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30min\u003csup\u003eb\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;224)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.905\u0026thinsp;\u0026plusmn;\u0026thinsp;1.216 \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7 (12.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.082\u0026thinsp;\u0026plusmn;\u0026thinsp;0.711 \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60min\u003csup\u003eb\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;210)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.378\u0026thinsp;\u0026plusmn;\u0026thinsp;0.967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.055\u0026thinsp;\u0026plusmn;\u0026thinsp;0.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e50 (28.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90min\u003csup\u003eb\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.508\u0026thinsp;\u0026plusmn;\u0026thinsp;0.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.443\u0026thinsp;\u0026plusmn;\u0026thinsp;0.813\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14 (13.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e120min\u003csup\u003eb\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.814\u0026thinsp;\u0026plusmn;\u0026thinsp;0.690\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.893\u0026thinsp;\u0026plusmn;\u0026thinsp;0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdmitted to NICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFor hypoglycemia (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e \u003cp\u003e6 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eShorter fast length was associated with glucose levels within 30 min after birth\u003c/h3\u003e\n\u003cp\u003eFast length of \u0026le;\u0026thinsp;7.6h was negatively associated with glucose levels in the baseline model (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) within 30 minutes after birth. Adjusting for risk factors for hypoglycemia reduced the β-estimate for the associations between fast length and glucose value but remained statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, the negative association between fast length and glucose concentrations was lost after the 30 minutes of birth (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eβ-estimate\u0026thinsp;\u0026plusmn;\u0026thinsp;95%CI for the association between fasting length and neonatal glucose values\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eBaseline model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAdjusted model\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFasting length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7.6h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.245 (-0.318, -0.172)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.232(-0.306, -0.158)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7.6 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.011(-0.029, 0.007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.013 (-0.031, 0.004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e30min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7.6h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.248(-0.395, -0.101)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.222(-0.377, -0.068)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7.6 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.017 (-0.066, 0.031)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.016 (-0.065, 0.033)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e60min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7.6h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.182 (-0.384, -0.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.189 (-0.459, 0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7.6 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.019 (-0.039, 0.076)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011 (-0.047, 0.068)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e90min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7.6h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.062 (-0.684, 0.808)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.585 (-0.879, 2.048)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7.6 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.016 (-0.064, 0.097)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02 (-0.065, 0.105)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.641\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e120min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7.6h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.091 (-0.513, 0.331)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.089 (-1.102, 0.923)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7.6 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.031 (-0.155, 0.093)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.04 (-0.171, 0.092)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eObstetrical, medical complications and neonatal hypoglycemia\u003c/h3\u003e\n\u003cp\u003e The impact of maternal complications on the identified associations was also evaluated by performing multiple linear regression analyses according to different fast lengths. BMI was positively associated with glucose values in neonates with maternal fast length of \u0026gt;\u0026thinsp;7.6h at birth (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the baseline and adjusted models). Medical or obstetrical complications including hypothyroidism and hypertensive disorders and the use of assisted reproductive technology (ART) were negatively associated with glucose values in prolonged fasting status at birth (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). However, these significant associations were negated following the prompt treatment with hypoglycemia after birth.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eβ-estimate\u0026thinsp;\u0026plusmn;\u0026thinsp;95%CI for the association between neonatal glucose values immediately at birth and maternal complications when fasting time\u0026thinsp;\u0026gt;\u0026thinsp;7.6 h\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.015 (0.002, 0.028)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.018 (0.005, 0.031)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.170 (-0.315, -0.025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.17 (-0.314, -0.026)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertensive disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.14 (-0.316, 0.035)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.195 (-0.381, -0.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.154 (-0.307, -0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.162 (-0.313, -0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMI=body mass index; ART= assisted reproductive technology\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings showed that the neonatal hypoglycemia prevalence at birth was increased with the prolonged time of preoperative maternal fasting, and we also demonstrated negative associations between shorter maternal fasting length (\u0026le;\u0026thinsp;7.6 hours) and neonatal blood glucose in the 30 minutes after birth. Following adjustment for risk factors for neonatal hypoglycemia, the strong negative associations remained between fasting length and neonatal blood glucose. Taken together our data supported the importance of the appropriate management of cesarean section such as preoperative maternal fasting length to reduce the chances of the babies being born with hypoglycemia.\u003c/p\u003e \u003cp\u003ePrevious studies have reported that the prevalence of neonatal hypoglycemia at birth exhibits fasting time-dependent increases[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. We made detailed subgroup analyses in this study, which further revealed the association between fasting time and neonatal blood glucose after birth. Interestingly, we observed that this impact of maternal fasting length on neonatal blood glucose was lost when maternal fasting exceeded 7.6 hours. In this condition, some maternal complications appeared to a greater impact on neonatal blood glucose. This suggests that the metabolic abnormality during pregnancy potentially influences underling tissue mechanisms to physiology of fetal glucose homeostasis. Similar to well-known risk factors of neonatal hypoglycemia, gestational hypertension has also been demonstrated to be the risk factor of neonatal hypoglycemia[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Roshni Vamja et al (2024) proposed the relationship between maternal thyroid dysfunction and adverse neonatal outcomes, including neonatal hypoglycemia[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], which is consistent with our findings in this study. It\u0026rsquo;s worth to note that obesity may contribute to improve the neonatal blood glucose concentration after birth. Maternal BMI has been directly associated with neonatal birth weight[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Neonatal fat mass could provide glycogen stores when blood glucose concentrations decrease[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], which may partly explain why maternal BMI was positively associated with neonatal glucose values.\u003c/p\u003e \u003cp\u003eDextrose gel has been recommended to manage hypoglycemia for first-line treatment[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. We observed that associations between maternal fasting time, Obstetrical, medical complications and neonatal blood levels were largely lost after gel administration. Prolonged maternal fasting time did not increase the difficulty of reversal of neonatal hypoglycemia.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn the present study, we demonstrated associations between maternal fasting time and neonatal blood concentrations. We further showed that treatment with dextrose gel is still effective and safe after long fasting time before delivery. Our findings highlight the adverse effects of inappropriate management of caesarean delivery and the effectiveness of dextrose gel administered orally. Maintaining appropriate obstetrical management could be a conventional way to reduce the occurrence of neonatal hypoglycemia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eblood glucose\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eART\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eassisted reproductive technology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e The study protocol was approved by the institutional review boards of affiliated hospital of Nantong university (NO: 2026-K015). Given the retrospective nature of the analysis, informed consent was waived by the Institutional Review Board.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting Interests:\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFundings:\u003c/h2\u003e \u003cp\u003eThis work has been supported by grants from the Open Project of Hainan Provincial Key Laboratory for Human Reproductive Medicine and Genetic Research (SZLAB202307), Nantong Municipal Health Commission (MS2023019) and Jiangsu Commission of Health (K2024033).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXirong Wu made substantial contributions to the design of the work and the analysis of data, Lin Mao drafted the work, Xue Chen and Chunyu Zhu collected the data, Xiaoli Sun revised this manuscript critically for important intellectual content, secured the funding and led the project. All authors approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThis study dataset related to the conclusions of the paper will be available to readers on request. Request to be sent to [email protected].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMarchioro L, Shokry E, Geraghty AA, et al. Caesarean section, but not induction of labour, is associated with major changes in cord blood metabolome. Sci Rep. 2019;9(1):17562.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHyde MJ, Mostyn A, Modi N, et al. The health implications of birth by Caesarean section. Biol Rev Camb Philos Soc. 2012;87(1):229\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFuchs KDM, Pac\u0026iacute;fico KHN, Pereira GC, de Sousa, et al. Hypoglycaemia management with a hypercaloric supplementation in neonatal puppies delivered by caesarean section. Reprod Domest Anim. 2023;58(10):1345\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakino Y, Kiguchi T, Hayashi K, et al. Association between pregnant women fasting duration and neonatal hypoglycemia: A prospective cohort study. Int J Gynaecol Obstet. 2024;165(1):361\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHillman NH, Kallapur SG, Jobe AH. Physiology of transition from intrauterine to extrauterine life. Clin Perinatol. 2012;39(4):769\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArab S, Yaghmaei M, Mokhtari M. The Effect of Various Pre-Cesarean Fasting Times on Maternal and Neonatal Outcomes. Adv Biomed Res. 2022;11:104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang D, Zhou X, Ning J, et al. Risk factors for neonatal hypoglycemia: a meta-analysis. BMC Endocr Disord. 2024;24(1):166.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVamja R, Patel YMM, et al. Impact of maternal thyroid dysfunction on fetal and maternal outcomes in pregnancy: a prospective cohort study. Clin Diabetes Endocrinol. 2024;10(1):50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGul R, Iqbal S, Anwar Z, et al. Pre-pregnancy maternal BMI as predictor of neonatal birth weight. PLoS ONE. 2020;15(10):e0240748.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun Y, Shen Z, Zhan Y, et al. Effects of pre-pregnancy body mass index and gestational weight gain on maternal and infant complications. BMC Pregnancy Childbirth. 2020;20(1):390.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiden EM, Burns N, Kahn LG, et al. Prenatal weight and regional body composition trajectories and neonatal body composition: The NICHD Foetal Growth Studies. Pediatr Obes. 2023;18(3):e12994.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThompson-Branch A, Havranek T. Neonatal Hypoglycemia Pediatr Rev. 2017;38(4):147\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarris DL, Weston PJ, Signal M, et al. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet. 2013;382(9910):2077\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"caesarean delivery, preoperative management, neonatal outcomes","lastPublishedDoi":"10.21203/rs.3.rs-9236114/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9236114/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo evaluate the relationship between preoperative fasting time and neonatal glucose levels and determine whether prolonged maternal fasting duration increased the difficulties of reversal of neonatal hypoglycemia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study included pregnant women who delivered by caesarean section from May 1, 2023 to May 1, 2024 and their neonates. Multivariable linear analyses were used to evaluate the association between fasting length and neonatal glucose values.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWhen fasting length\u0026thinsp;\u0026le;\u0026thinsp;7.6 hours, neonatal glucose levels in the 30 minutes of birth were negatively associated with the maternal fasting duration. When maternal fasting length of \u0026gt;\u0026thinsp;7.6 hours, obstetrical complications rather than maternal fasting time existed negative associations with neonatal glucose levels immediately at birth. Treatment with dextrose gel was still effective for reversal of neonatal hypoglycemia.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMaternal fasting time and obstetrical complications are required for appropriate preoperative management. Treatment with dextrose gel is still an effective intervention.\u003c/p\u003e","manuscriptTitle":"The effects of perioperative fasting duration on neonatal hypoglycemia in caesarean delivery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 10:59:00","doi":"10.21203/rs.3.rs-9236114/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-06T19:22:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260063568918687887297276902249184452914","date":"2026-04-29T16:43:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-29T12:30:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-26T22:03:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-06T19:29:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-03T12:48:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-04-03T12:43:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"192eb6e1-e266-4129-b2e4-292672cff280","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-06T19:22:21+00:00","index":42,"fulltext":""},{"type":"reviewerAgreed","content":"260063568918687887297276902249184452914","date":"2026-04-29T16:43:14+00:00","index":41,"fulltext":""},{"type":"reviewersInvited","content":"30","date":"2026-04-29T12:30:39+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T10:59:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 10:59:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9236114","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9236114","identity":"rs-9236114","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}