Umbilical cord asprosin and subfatin levels in relation to neonatal metabolic outcomes in gestational diabetes mellitus: a cross-sectional study

Abstract

Background Gestational diabetes mellitus (GDM) is a common pregnancy complication that may influence the intrauterine metabolic environment and neonatal glucose regulation. Novel adipokines such as asprosin and subfatin have been implicated in glucose homeostasis. This study aimed to evaluate umbilical cord blood levels of asprosin and subfatin in pregnancies complicated by GDM and to examine their associations with neonatal clinical and metabolic outcomes. Methods This cross-sectional study included 40 women with GDM, 40 healthy pregnant women, and their newborns who delivered at Balıkesir University Faculty of Medicine Hospital between August 2025 and October 2025. Maternal demographic characteristics, 75-g oral glucose tolerance test results, HbA1c levels and GDM treatment modality were recorded. Neonatal outcomes included Apgar scores, birth weight, early postnatal blood glucose levels, weight at one month and feeding mode. Umbilical cord blood asprosin and subfatin concentrations were measured using ELISA. Results Mothers with GDM were older and had higher fasting glucose, 1- and 2-hour OGTT glucose levels, HbA1c and body mass index compared with controls (all p<0.01). Infants born to mothers with GDM had higher birth weight (p=0.007) and greater weight at one month (p=0.01), while neonatal blood glucose levels were significantly lower during early postnatal follow-up (p<0.001). In unadjusted analyses, umbilical cord asprosin (23.15±10.21 vs. 35.63±26.97 ng/mL, p=0.01) and subfatin levels (2.85±1.45 vs. 4.17±3.11 ng/mL, p=0.03) were lower in the GDM group. However, these differences were no longer statistically significant after multivariable adjustment (MANCOVA) for maternal age, body mass index, fetal sex and GDM treatment modality. In contrast, early neonatal blood glucose levels remained significantly lower in the GDM group after multivariable adjustment. Conclusions Pregnancies complicated by GDM are associated with differences in neonatal growth and glucose regulation, while alterations in umbilical cord adipokine levels appear to be influenced by maternal and fetal characteristics rather than representing independent effects of GDM. These findings suggest that cord blood