Non-diabetic-range maternal glucose levels and perinatal factors are associated with early neonatal hypoglycemia in term appropriate-for-gestational-age infants

Introduction Neonatal hypoglycemia (NH) is a common perinatal metabolic disorder. Although term appropriate-for-gestational-age (AGA) infants born to mothers without diabetes are generally considered to be at lower risk of NH, early hypoglycemia may still occur in those undergoing clinically indicated glucose monitoring. However, the association between maternal glucose variation within the non-diabetic range and NH remains unclear. Therefore, we investigated maternal metabolic characteristics and perinatal factors associated with early hypoglycemia in this population. Methods This retrospective observational cohort study with a matched analysis included term AGA infants born to mothers without diabetes at The First Affiliated Hospital of Xiamen University between January 2019 and January 2026. Infants with and without hypoglycemia within 24 h of birth were matched at a 1:4 ratio using nearest-neighbor matching based on sex and gestational age. Conditional logistic regression, restricted cubic spline (RCS) analysis, and sensitivity analyses were performed. Results Among 820 matched infants, 164 developed early hypoglycemia. Higher maternal oral glucose tolerance test (OGTT) fasting (0-h) plasma glucose (odds ratio [OR] per 1 mmol/L increase = 2.84, 95% confidence interval [CI]: 1.50–5.40) and 1-h glucose levels (OR per 1 mmol/L increase = 1.35, 95% CI: 1.12–1.63) were associated with early NH. Higher maternal platelet count and cesarean delivery were also associated with early NH. RCS analysis suggested possible nonlinear associations of maternal age, platelet count, and total bile acid level with early NH. Sensitivity analyses supported these findings. Discussion Maternal glucose levels within the non-diabetic range were associated with early NH in glucose-monitored term AGA infants. Factors associated with NH may extend beyond maternal diabetes status to include maternal metabolic characteristics and perinatal factors.