Association between maternal stress hormone levels during labor induction and the occurrence of neonatal hyperbilirubinemia.

OBJECTIVE

To investigate the relationship between changes in maternal stress hormone levels during labor induction and the occurrence of neonatal hyperbilirubinemia (NNH), and to identify potential independent risk factors.

METHODS

A prospective cohort study was conducted involving 1,000 pregnant women who underwent labor induction at our hospital between June 2022 and May 2025. Maternal plasma levels of cortisol, epinephrine (EPI), and norepinephrine (NE) were measured before induction (T0), during induction (T1), and 30 min after delivery (T2). Neonatal total bilirubin concentrations were measured at 24, 48, and 72 h after birth. According to the occurrence of NNH, subjects were divided into the NNH group (n = 95) and the non-NNH group (n = 905). Hormonal and bilirubin changes were compared between the two groups. Point-biserial correlation and multivariate logistic regression analyses were performed to explore associations and identify independent predictors.

RESULTS

Maternal plasma levels of cortisol, EPI, and NE at T1 and T2 were significantly higher in the NNH group. All three hormones at T2 showed moderate positive correlations with the occurrence of NNH (r = 0.28-0.31, p < 0.001). Cortisol, EPI, and NE at T2 were independently associated with the occurrence of NNH, while gestational age served as a protective factor. Male sex, cephalohematoma, direct antiglobulin test (DAT) positivity, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and exclusive breastfeeding were all associated with a higher risk of NNH. The regression model showed strong discriminatory power and predictive performance.

CONCLUSION

Elevated maternal stress hormone levels during labor induction may serve as potential predictive indicators for assessing the risk of NNH.