Delivery Mode and Risk of Neonatal Hypoglycemia in Gestational Diabetes Mellitus: A Retrospective Study

Background: Neonatal hypoglycemia (NH) is a common metabolic complication among infants born to mothers with gestational diabetes mellitus (GDM) and may adversely affect neurodevelopment. Delivery mode, particularly cesarean section (CS), has been proposed as a potential risk factor for NH; however, existing evidence remains inconsistent. This study aimed to evaluate the association between delivery mode and the risk of NH in pregnancies complicated by GDM. Methods: This retrospective study included women with GDM who delivered at ≥35 weeks of gestation at Anhui No.2 Provincial People’s Hospital between January 2024 and December 2024. NH was defined as any blood glucose measurement <2.6 mmol/L within the first 24 hours of life, consistent with American Academy of Pediatrics guidelines. Maternal and neonatal characteristics were compared between the NH and non-NH groups. Independent risk factors for NH were identified using multivariable logistic regression. The predictive performance of CS for NH was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Among 201 women with GDM who met the inclusion criteria, 44 neonates (21.89%) developed NH. The rate of CS was significantly higher in the NH group compared with the non-NH group (81.82% vs. 39.49%, p < 0.001). After adjustment for potential confounders, CS remained an independent risk factor for NH (adjusted odds ratio [OR] = 4.48, 95% confidence interval [CI]: 1.56–12.87; p = 0.005). CS was associated with a sensitivity of 81.8%, a specificity of 60.5%, a PPV of 36.7%, and an NPV of 92.2% for NH. Conclusions: CS independently increases the risk of NH in infants born to mothers with GDM. Delivery mode should be considered in perinatal management strategies to improve early identification and prevention of NH.