Glucose, Insulin, and Lipids in Cord Blood of Neonates and Their Association with Birthweight: Differential Metabolic Risk of Large for Gestational Age and Small for Gestational Age Babies

J Pediatr. 2020 May:220:64-72.e2. doi: 10.1016/j.jpeds.2020.01.013. Epub 2020 Feb 21.


Objectives: To investigate the association of birthweight percentile with cord blood glucose, lipids, and insulin levels.

Study design: Data obtained from 1522 newborns were included in the Born in Guangzhou Cohort study. The generalized additive model and multivariable linear regression model were used to explore the nonlinear and linear relationships between birthweight and cord blood metabolic measures, and to evaluate the differences of metabolic measures Z-scores among small for gestational age, appropriate for gestational age, and large for gestational age babies.

Results: Birthweight Z-score was linearly associated with increased cord blood insulin Z-score (adjusted β = 0.30; 95% CI, 0.22-0.37). Compared with appropriate for gestational age babies, neonates born small for gestational age had significantly higher cord blood triglycerides Z-score (adjusted mean difference [MDadj], 0.60; 95% CI, 0.40-0.79) and lower cord blood insulin (MDadj, -0.37; 95% CI, -0.57 to -0.16), high-density lipoprotein cholesterol (MDadj, -0.34; 95% CI, -0.55 to -0.13), total cholesterol (MDadj, -0.26; 95% CI, -0.47 to -0.05), and low-density lipoprotein (MDadj, -0.23; 95% CI, -0.43 to -0.02) Z-scores, and neonates born large for gestational age had higher cord blood insulin Z-score (MDadj, 0.31; 95% CI, 0.09 to 0.52).

Conclusions: Our findings support the hypothesis that babies born small for gestational age and large for gestational age are exposed to different intrauterine environments, which may contribute to altered fat accumulation patterns with implications for the risk of metabolic dysfunction later in life. There is a need to consider the development of tailored intervention strategies to prevent metabolic dysfunction in adult life for these babies.

Keywords: birthweight; cholesterol; insulin; obesity; triglycerides.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Birth Weight*
  • Blood Glucose*
  • Female
  • Fetal Blood*
  • Humans
  • Infant, Newborn / blood
  • Infant, Small for Gestational Age / blood*
  • Insulin / blood*
  • Lipids / blood*
  • Male
  • Multivariate Analysis
  • Pregnancy


  • Blood Glucose
  • Insulin
  • Lipids