Journal List > Korean J Perinatol > v.27(2) > 1013802

Korean J Perinatol. 2016 Jun;27(2):95-102. Korean.
Published online June 30, 2016.
Copyright © 2016 The Korean Society of Perinatology
Glucose Homeostasis during Fetal and Neonatal Period
Won Im Cho, M.D. and Hye Rim Chung, M.D., Ph.D.
Departemnet of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.

Correspondence to: Hye Rim Chung. Department of Pediatrics, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620 Korea. Tel: +82-31-787-7292, Fax: +82-31-787-4054, Email:
Received June 19, 2016; Revised June 29, 2016; Accepted June 30, 2016.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Glucose is essential for energy metabolism in human, especially in brain, and is a source of energy storage in the form of glycogen, fat and protein. During fetal life, the predominant source of energy is also glucose, which crosses the placenta by facilitated diffusion. There is very little endogenous glucose production under normal circumstances during fetal life. During labor, the fetus is exposed to physiological challenges that require metabolic adaptation. A healthy infant successfully manages the postnatal transition by mobilizing and using alternative. After birth, there is a rapid surge in catecholamine and glucagon levels, and a steady decrease in insulin, as blood glucose levels decline. These hormonal changes induce enzyme activities that lead to glycogenolysis and gluconeogenesis. During the first 24–48 hours of life, plasma glucose concentrations of neonates are typically lower than later in life. Distinguishing between transitional neonatal glucose regulation in normal neonates and hypoglycemia that persists or occurs for the first time beyond the first 72 hours of life is important for prompt diagnosis and treatment to avoid serious consequences.

Keywords: Glucose; Fetus; Neonate; Hypoglycemia


Fig. 1
Screening for and management of postnatal glucose homeostasis in late-preterm (gestational age 34 -36+6 weeks) and term small-for-gestational age infants and infants who were born to mothers with diabetes, large-for-gestational age infants. Modified from Pediatrics 2011;127:575-9.8
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Table 2
Neonates at Increased Risk for a Persistent Hypoglycemia Disorder
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1. Filan PM, Inder TE, Cameron FJ, Kean MJ, Hunt RW. Neonatal hypoglycemia and occipital cerebral injury. J Pediatr 2006;148:552–555.
2. Sinclair JC. In: Metabolic rate and temperature control in the newborn. Baltimore: Williams and Wilkins; 1976. pp. 558-577.
3. Galerneau F, Inzucchi SE. Diabetes mellitus in pregnancy. Obstet Gynecol Clin North Am 2004;31:907–933. xi–xii.
4. Stanley CA, Rozance PJ, Thornton PS, De Leon DD, Harris D, Haymond MW, et al. Re-evaluating "transitional neonatal hypoglycemia": mechanism and implications for management. J Pediatr 2015;166:1520–1525.e1.
5. Thornton PS, Stanley CA, De Leon DD, Harris D, Haymond MW, Hussain K, et al. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. J Pediatr 2015;167:238–245.
6. Boardman JP, Wusthoff CJ, Cowan FM. Hypoglycaemia and neonatal brain injury. Arch Dis Child Educ Pract Ed 2013;98:2–6.
7. Hawdon JM. Definition of neonatal hypoglycaemia: time for a rethink? Arch Dis Child Fetal Neonatal Ed 2013;98:F382–F383.
8. Committee on Fetus and NewbornAdamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011;127:575–579.
9. Rozance PJ. Update on neonatal hypoglycemia. Curr Opin Endocrinol Diabetes Obes 2014;21:45–50.
10. Hay WW Jr, Raju TN, Higgins RD, Kalhan SC, Devaskar SU. Knowledge gaps and research needs for understanding and treating neonatal hypoglycemia: workshop report from Eunice Kennedy Shriver National Institute of Child Health and Human Development. J Pediatr 2009;155:612–617.
11. Morriss FH Jr, Makowski EL, Meschia G, Battaglia FC. The glucose/oxygen quotient of the term human fetus. Biol Neonate 1974;25:44–52.
12. Marconi AM, Cetin I, Davoli E, Baggiani AM, Fanelli R, Fennessey PV, et al. An evaluation of fetal glucogenesis in intrauterine growth-retarded pregnancies. Metabolism 1993;42:860–864.
13. Kalhan SC, Parimi P, Van Beek R, Gilfillan C, Saker F, Gruca L, et al. Estimation of gluconeogenesis in newborn infants. Am J Physiol Endocrinol Metab 2001;281:E991–E997.
14. Whaley WH, Zuspan FP, Nelson GH. Correlation between maternal and fetal plasma levels of glucose and free fatty acids. Am J Obstet Gynecol 1966;94:419–421.
15. Hay WW Jr. Placental-fetal glucose exchange and fetal glucose metabolism. Trans Am Clin Climatol Assoc 2006;117:321–339.
16. Devaskar SU, Mueckler MM. The mammalian glucose transporters. Pediatr Res 1992;31:1–13.
17. Gao L, Lv C, Xu C, Li Y, Cui X, Gu H, et al. Differential regulation of glucose transporters mediated by CRH receptor type 1 and type 2 in human placental trophoblasts. Endocrinology 2012;153:1464–1471.
18. Rao PN, Shashidhar A, Ashok C. In utero fuel homeostasis: Lessons for a clinician. Indian J Endocrinol Metab 2013;17:60–68.
19. Hauguel S, Desmaizieres V, Challier JC. Glucose uptake, utilization, and transfer by the human placenta as functions of maternal glucose concentration. Pediatr Res 1986;20:269–273.
20. Hay WW Jr, Sparks JW. Placental, fetal, and neonatal carbohydrate metabolism. Clin Obstet Gynecol 1985;28:473–485.
21. Capková A, Jirásek JE. Glycogen reserves in organs of human foetuses in the first half of pregnancy. Biol Neonat 1968;13:129–142.
22. Kalhan S, Parimi P. Gluconeogenesis in the fetus and neonate. Semin Perinatol 2000;24:94–106.
23. Girard J. Gluconeogenesis in late fetal and early neonatal life. Biol Neonate 1986;50:237–258.
24. Hay WW Jr, Sparks JW, Quissell BJ, Battaglia FC, Meschia G. Simultaneous measurements of umbilical uptake, fetal utilization rate, and fetal turnover rate of glucose. Am J Physiol 1981;240:E662–E668.
25. Edlund H. Pancreatic organogenesis--developmental mechanisms and implications for therapy. Nat Rev Genet 2002;3:524–532.
26. Sperling MA, Ganguli S, Leslie N, Landt K. Fetal-perinatal catecholamine secretion: role in perinatal glucose homeostasis. Am J Physiol 1984;247:E69–E74.
27. Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. In: Wiiliams textbook of endocrinology. 11th ed. Philadelphia: Saunders Co; 2007.
28. Rosenn BM, Miodovnik M, Khoury JC, Siddiqi TA. Counterregulatory hormonal responses to hypoglycemia during pregnancy. Obstet Gynecol 1996;87:568–574.
29. Sperling MA, DeLamater PV, Phelps D, Fiser RH, Oh W, Fisher DA. Spontaneous and amino acid-stimulated glucagon secretion in the immediate postnatal period. Relation to glucose and insulin. J Clin Invest 1974;53:1159–1166.
30. Granner D, Andreone T, Sasaki K, Beale E. Inhibition of transcription of the phosphoenolpyruvate carboxykinase gene by insulin. Nature 1983;305:549–551.
31. Stanley CA, Anday EK, Baker L, Delivoria-Papadopolous M. Metabolic fuel and hormone responses to fasting in newborn infants. Pediatrics 1979;64:613–619.
32. Alkalay AL, Sarnat HB, Flores-Sarnat L, Elashoff JD, Farber SJ, Simmons CF. Population meta-analysis of low plasma glucose thresholds in full-term normal newborns. Am J Perinatol 2006;23:115–119.
33. Adamkin DH. Neonatal hypoglycemia. Curr Opin Pediatr 2016;28:150–155.
34. Rozance PJ, Hay NW. Neonatal hypoglycemia answers but more questions. J Pediatr 2012;16:775–776.
35. Rozance PJ, Hay WW Jr. New approaches to management of neonatal hypoglycemia. Matern Health Neonatol Perinatol 2016;2:3.
36. Giep TN, Hall RT, Harris K, Barrick B, Smith S. Evaluation of neonatal whole blood versus plasma glucose concentration by ion-selective electrode technology and comparison with two whole blood chromogen test strip methods. J Perinatol 1996;16:244–249.
37. Maisels MJ, Lee C. Chemstrip glucose test strips: correlation with true glucose values less than 80 mg/dL. Crit Care Med 1983;11:293–295.
38. Menni F, de Lonlay P, Sevin C, Touati G, Peigne C, Barbier V, et al. Neurologic outcomes of 90 neonates and infants with persistent hyperinsulinemic hypoglycemia. Pediatrics 2001;107:476–479.
39. Meissner T, Wendel U, Burgard P, Schaetzle S, Mayatepek E. Long-term follow-up of 114 patients with congenital hyperinsulinism. Eur J Endocrinol 2003;149:43–51.
40. Cornblath M, Reisner SH. Blood glucose in the neonate and its clinical significance. N Engl J Med 1965;273:378–381.
41. Sacks DB. Carbohydrates. In: Burtis CA, Ashwood ER, editors. Tietz textbook of clinical chemistry. 2nd ed. Philadelphia: WB Saunders; 1994.