Early metabolic biomarkers in neonates of diabetic mothers: predictive insights from amino acid and acylcarnitine profiling.

OBJECTIVE

To investigate early metabolic biomarkers in neonates born to mothers with gestational diabetes mellitus (GDM), focusing on amino acid and acylcarnitine profiles to assess metabolic risk, including obesity and future metabolic syndrome.

METHODS

This retrospective study analyzed dried blood spot samples from 184 GDM and 167 control neonates. GDM was categorized as large-for-gestational-age (LGA) or appropriate-for-gestational-age (AGA). Amino acid and acylcarnitine concentrations at 24-48 h postnatal age were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Neonatal hypoglycemia was defined and managed according to standard guidelines. Principal component analysis (PCA) was performed to identify clustering patterns.

RESULTS

Tyrosine concentrations were significantly lower in the GDM-LGA group compared to the control-AGA group (p = 0.018). Total carnitine levels were higher in GDM-LGA infants relative to controls (p < 0.05), reflecting increased fatty acid mobilization in larger infants. Specific long-chain acylcarnitines, such as C18:1 and C18:2, were lower in GDM group. whereas stearoyl carnitine (C18:0) was elevated, indicating an altered fatty acid oxidation profile. PCA revealed distinct metabolic patterns, suggesting early metabolic heterogeneity in GDM.

CONCLUSION

The study identifies distinctive early metabolic profiles in neonates of gestational diabetic mothers, including lower tyrosine and altered acylcarnitine patterns, which may signal a predisposition to metabolic disorders. These findings support early metabolic screening protocols and targeted follow-up for high-risk infants. Longitudinal studies are warranted to confirm the predictive value of these biomarkers and to clarify the long-term impacts of metabolic disturbances in GDMs.