Late preterm hypoglycemia not tied to neurodevelopment at age 6

Neonatal hypoglycemia in the late preterm period was not associated with adverse neurodevelopmental outcomes in children assessed at age 6 years or older, according to a prospective follow-up study published in Obstetrics & Gynecology.¹

The study drew from the Antenatal Late Preterm Steroids (ALPS) multicenter randomized trial, conducted at 13 centers participating in the Maternal-Fetal Medicine Units Network from 2011 to 2016, with follow-up spanning 2017 to 2022. The analysis evaluated 1,026 enrolled children whose mothers had been at risk for late preterm delivery. Of these, 1,020 (99.4%) had blood glucose data available, and 944 had data for the primary neurodevelopmental outcome.¹

The primary exposure was hypoglycemia, defined as a blood glucose concentration below 40 mg/dL within 24 hours of birth. Of the 944 children with outcome data, 785 (83.2%) were delivered late preterm and 208 (22.0%) had hypoglycemia, of whom 84 (40.4%) received treatment. Children with hypoglycemia were more likely to have private insurance, have older mothers, have received antenatal betamethasone, and identify as White.¹

The primary outcome was the proportion of children scoring below 85 on the General Conceptual Ability (GCA) scale of the Differential Ability Scales, 2nd Edition (DAS-II), representing performance more than 1 standard deviation below the mean. Outcomes were analyzed by the presence or absence of hypoglycemia at birth, regardless of initial trial treatment assignment.¹

No significant difference in the primary outcome was identified. GCA scores below 85 occurred in 15.9% of children with hypoglycemia vs. 18.5% of those without hypoglycemia (adjusted relative risk 1.03; 95% CI, 0.74–1.45). Severity of hypoglycemia was also not associated with any outcomes.¹

“This study found that there was no association between hypoglycemia in infants born after 34 weeks and adverse neurodevelopment,” said corresponding author Cynthia Gyamfi-Bannerman, MD, MS, Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, in an email correspondence with Contemporary OB/GYN.

“Previously, there had been some association between preterm hypoglycemia and possible cognitive impairment but our findings suggest that this may not be true at later gestational ages,” said Gyamfi-Bannerman.²

What did secondary neurodevelopmental outcomes show?

Secondary outcomes assessed included Gross Motor Function Classification System (GMFCS) level, Social Responsiveness Scale, 2nd Edition (SRS-2) scores, and Child Behavior Checklist (CBCL) scores. No significant differences were identified across any of these measures between children with and without neonatal hypoglycemia. Univariable and multivariable analyses were performed, with the latter adjusted for prespecified variables known to be associated with the primary outcome.¹

How should these findings influence clinical practice and patient counseling?

When asked whether the findings should prompt changes to current hypoglycemia screening and treatment thresholds in late preterm infants, Gyamfi-Bannerman indicated the results are not intended to alter immediate neonatal triage protocols.

“These protocols are designed by pediatricians to assess infants at birth that may require treatment (early feeding, IV fluids, or other glucose supplement) for hypoglycemia, so it would not appear that these findings should alter that immediate clinical triage,” she said.²

For patients at risk for late preterm delivery, the findings carry practical relevance in the context of the original ALPS trial, in which betamethasone exposure was associated with an increased likelihood of neonatal hypoglycemia. Gyamfi-Bannerman noted that this study, together with a prior ALPS follow-up examining the neurodevelopmental effects of antenatal corticosteroids, provides reassurance on both fronts.²

“What this study and our other previous study showed were that neither the treatment allocation (betamethasone vs. placebo), nor the presence of hypoglycemia influenced neurodevelopment adversely,” she said.²

References

1. Gyamfi-Bannerman C, de Voest J, Tita A, et al. Child neurodevelopmental outcomes after late preterm hypoglycemia. Obstet Gynecol. Published July 16, 2026. Accessed July 27, 2026. https://journals.lww.com/greenjournal/abstract/10.1097/aog.0000000000006366~child-neurodevelopmental-outcomes-after-late-preterm?redirectionsource=fulltextview
2. Gyamfi-Bannerman C. Email correspondence. Contemporary OB/GYN. July 27, 2026.