Evaluating the relationship of in utero nicotine exposure with hypoglycemia after delivery: An observational study

Article type: Research Article

Authors: Johnson, Mary G.^{a; b; *} | Suchting, Robert^c | Scheid, Lisa M.^{a; d} | Holzapfel, Lindsay N.^a | Chalise, Aditi^e | Stotts, Angela L.^{c; f; *} | Chapman, John C.^a | Khan, Amir M.^a | Northrup, Thomas F.^{f; *}

Affiliations: [a] Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Centerat Houston [UTHealth], Houston, TX, USA | [b] Department of Pediatrics, Division of Neonatology, Louisiana State University Health Science Center, New Orleans, LA, USA | [c] Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA | [d] Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA | [e] McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA | [f] Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Centerat Houston [UTHealth], Houston, TX, USA

Correspondence: [*] Address for correspondences: Mary Johnson, MD, Department of Pediatrics (Neonatology), LSU Health, 200 Henry Clay Ave, New Orleans, LA 70118, USA. Tel.: +1 504 896 9418; E-mail: [email protected] and Angela L. Stotts, Ph.D., Department of Family and Community Medicine, UTHealth, 6431Fannin, JJL 324, Houston, TX 77030, USA. Tel.: +1 713 500 7590; E-mail: [email protected] and Thomas F. Northrup, Ph.D., Department of Family and Community Medicine, UTHealth, 6431Fannin, JJL 324, Houston, TX 77030, USA. Tel.: +1 713 500 7590; Thomas F. E-mail: [email protected].

Abstract: BACKGROUND: Hypoglycemia in neonates is common and contributes to 4.0–5.8% of neonatal intensive care unit (NICU) admissions. In utero nicotine exposure is underexplored as a potential contributor to neonatal hypoglycemia. Rat models have shown that in utero nicotine exposure can be associated with a reduction in pancreatic beta cell mass, leading to glucose dysregulation. The primary aim of this work is to study the risk of developing hypoglycemia after birth in a population of in utero nicotine-exposed neonates. METHODS: We conducted a retrospective matched cohort study that augmented an existing dataset of neonates admitted to a level IV NICU with household-based in utero nicotine exposure (N = 335). Neonates in the control group parents denied household smoking (N = 325), were born within a 6-month timeframe, and were within a birthweight of 50 grams of a nicotine-exposed neonate. Data reviewed included gestational age, growth parameters, maternal history of diabetes, and glucose levels within the first three hours of life per unit protocol. RESULTS: 660 neonates were included in the analysis. In utero nicotine exposure demonstrated a 94.3% posterior probability (PP) for greater hypoglycemia risk (RR = 1.185, 95% CrI = [0.953, 1.445]). A 94.6% PP was demonstrated when neonates who were small for gestational age, intrauterine growth-restricted, and born to diabetic mothers were excluded (n = 482; RR = 1.271, 95% CrI = [0.946, 1.669]). CONCLUSION:Nicotine exposure in utero was found to be a potential risk factor for developing hypoglycemia after birth. Mechanisms of action should be explored, and additional research on in utero nicotine exposure risks should follow.

Keywords: Late preterm neonate, maternal substance use, neonatal hypoglycemia, neonatology, nicotine exposure

DOI: 10.3233/NPM-230124

Journal: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 3, pp. 445-452, 2023