Predictive value of umbilical cord blood NSE and BDNF levels combined with NBNA scores for short-term neurodevelopment in offspring of mothers with gestational diabetes mellitus

To evaluate the predictive value of umbilical cord blood neuron-specific enolase (NSE) and brain-derived neurotrophic factor (BDNF) levels, in combination with Neonatal Behavioral Neurological Assessment (NBNA) scores, for neurodevelopmental outcomes at 6 months in offspring of mothers with gestational diabetes mellitus (GDM). A prospective cohort of 140 term neonates born to mothers with GDM at Suzhou High-tech Zone People’s Hospital from January 2023 to December 2024 was included. Cord blood NSE and BDNF levels were measured at birth, and NBNA was performed on postnatal day 3. At 6 months, neurodevelopment was assessed using the Gesell Developmental Scales. Infants were stratified into an abnormal group (developmental quotient [DQ] < 85) and a normal group (DQ ≥ 85). Between-group differences were analyzed. Receiver operating characteristic (ROC) curves were constructed to assess the predictive performance of individual and combined indicators. Twenty-seven infants (19.3%) were classified as abnormal and 113 (80.7%) as normal. The abnormal group exhibited significantly higher cord blood NSE levels and lower BDNF levels compared with the normal group ( P < 0.01). NBNA scores were significantly lower, and the proportion of NBNA abnormality was higher in the abnormal group ( P < 0.01). Multivariate analysis identified elevated NSE as an independent risk factor for abnormal neurodevelopment, whereas higher BDNF levels and NBNA scores were protective factors ( P < 0.05; P < 0.01). The combined model yielded an AUC of 0.873 (95% CI: 0.786–0.961), with a sensitivity of 77.78% and specificity of 89.38%. Elevated cord blood NSE, reduced BDNF levels, and lower NBNA scores are significantly associated with adverse neurodevelopmental outcomes at 6 months in offspring of mothers with GDM. The combined assessment demonstrates favorable predictive performance for early identification of neurodevelopmental risk, although longer follow-up is needed to determine its value for predicting definitive long-term neurodevelopmental disorders.