Serum ELABELA concentrations in infants of gestational diabetic mothers and small-for-gestational-age neonates: a prospective study

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Abstract Background Infants born to mothers with Gestational Diabetes Mellitus (GDM) and those born Small for Gestational Age (SGA) undergo cardiac remodeling as a result of intrauterine metabolic and hemodynamic influences. ELABELA plays a key role in embryonic vasculogenesis and cardiovascular development. The study aimed to investigate the relationship between serum ELABELA concentrations and cardiac findings in GDM-exposed and SGA neonates. Methods In this prospective study, serum ELABELA levels were measured in 78 neonates divided into three groups: infants of GDM mothers ( n = 24), SGA infants ( n = 24), and healthy controls ( n = 30). Echocardiographic evaluation was performed between postnatal days 3 and 5. Demographic, laboratory, and echocardiographic data were compared across groups. Receiver Operating Characteristic (ROC) analysis was used to evaluate the diagnostic performance of ELABELA. Results Aortic annulus measurements were significantly lower in the SGA group compared with the GDM and control groups ( p = 0.001). ELABELA showed good discriminatory ability for distinguishing SGA infants from controls (AUC: 0.816, p < 0.001), with an optimal cut-off value of 202.6 units (sensitivity: 73.3%, specificity: 83.3%). For GDM infants, ELABELA also showed discriminatory ability (AUC: 0.721, p = 0.009). No significant association was observed between ELABELA levels and the assessed echocardiographic parameters. Conclusion Serum ELABELA levels were higher in GDM-exposed and SGA neonates than in healthy controls. The biological significance of this elevation and its relationship with intrauterine conditions remain uncertain. Although ELABELA demonstrated discriminatory ability between high-risk neonatal groups and controls, no significant association with echocardiographic abnormalities was observed. Further longitudinal studies are needed to determine its clinical and prognostic significance.