**14. Conclusion**

**MDA <7 (N = 11)**

90 Umbilical Cord Blood Banking for Clinical Application and Regenerative Medicine

Age (years) 28.18 ± 5.42 31.90 ± 5.17 0.078 Glucose (mg/dL) 80.44 ± 6.46 84.24 ± 7.36 NS

Weight (g) 3140 ± 419 3309 ± 275 NS Length (cm) 49.68 ± 0.46 50.20 ± 1.27 NS

Glucose (mg/dL) 93.91 ± 31.28 70.70 ± 14.84 0.044 Insulin (μIU/mL) 12.46 ± 10.69 3.98 ± 3.24 0.040 Cortisol (μg/dL) 8.93 ± 3.46 7.14 ± 2.56 NS GH (ng/mL) 17.20 ± 13.01 17.49 ± 9.25 NS IGF-1 (ng/mL) 58.41 ± 32.02 57.55 ± 28.11 NS HOMA-IR 3.69 ± 5.25 0.73 ± 0.67 0.038 QUICKI 0.39 ± 0.07 0.45 ± 0.14 NS Glucose/insulin 17.49 ± 10.61 40.30 ± 41.71 NS Insulin/cortisol 1.94 ± 2.98 0.60 ± 0.47 0.057

) 12.72 ± 1.66 13.13 ± 1.02 NS

Data are means ± standard deviations; BMI, body mass index; GH, growth hormone; IGF-1: insulin-like growth factor-1; QUICKI, quantitative insulin sensitivity check index; HOMA-IR, homeostatic model assessment-insulin

**Table 8.** Effects of maternal adherence to mediterranean diet (MDA) during pregnancy on different neonatal

markers were conceptually those of prediabetes [12, 13].

Thus, the conjoint presence of high cortisolaemia–high insulinaemia at birth was clearly associated with pregnancy diet characteristics. In no case, neonatal hyperinsulinaemia or neonatal hyperinsulinaemia *plus* hypercortisolaemia was found in children whose mothers' diets had a MDA ≥7 over 13. Thus, those findings suggest a clear relationship between pregnancy diet quality and high neonatal insulinaemia. Almost 50% of neonates, whose mothers' diets were inadequate, according to the MDA score, presented hyperinsulinaemia *plus* hypercortisolaemia at birth. Previously we reported that a relatively high pregnancy MDA was a guarantee for glucose, insulin, HOMA-IR and QUICKI normal values, while mothers with a poor MDA score delivered neonates whose plasma insulin sensitivity/resistance

Thus, in the absence of known factors (reduced gestational age, reduced neonatal body weight, foetal distress) that would suggest limited and stressed gestation, pregnancy diet characteristics (MDA) clearly affect glycaemic hormone balance, and thus insulin sensitivity/resistance

) 25.61 ± 3.33 26.18 ± 2.26 NS

*Mothers*

*Neonates*

BMI (kg/m2

Ponderal index (kg/m3

resistance; NS, not significant.

parameters.

at birth.

**MDA ≥7 (N = 20)**

**Significance**

The results of this chapter show the importance of analysing insulin and cortisol cord-blood concentrations even in term, normoweight neonates. Results show for the first time on the international bibliography that about 9% of term, normoweight, without foetal-distress neonates, showed increased values (≥P75 of reference values) for both cord-blood insulin and cortisol.

The insulinaemia affected the insulin sensitivity/resistance markers more than cortisolaemia in the different neonate groups classified according to cortisol and insulin levels. In those neonates, GH values appear decreased, a fact that in addition to the join presence of high cortisol-high insulin induces decreases in insulin sensitivity in those neonates without affecting body weight as they were normoweight. IGT was more prevalent in mothers whose neonates were hyperinsulinaemic at birth. In addition, a follow-up study of this neonatal population is needed in order to assess the importance of the present findings. Mothers with adequate MDA score diet delivered newborns presenting healthier insulin and cortisol profiles. This finding suggests the benefits of following an adequate diet through gestation. It will allow the design of future interventions aimed to decrease the metabolic syndrome risk later in life.

#### **Abbreviations**

ACTH, adrenocorticotropic hormone; BMI, body mass index; CBG, cortisol binding globulin; CRH, corticotropin-releasing hormone; DHAS, dehydroepiandrosterone sulphate; , GD, gestational diabetes; GH, growth hormone; GR, glucocorticoid receptor; HDL, high-density lipoproteins; HOMA-IR, homeostatic model assessment-insulin resistance; HPA, hypophysispituitary axis; hPL, human placental lactogen; HSD, hydroxysteroid dehydrogenase; IGF, insulin-like growth factor; IGFBP, insulin-like growth factor binding protein; IGT, impaired glucose tolerance; IUGR, intrauterine growth retardation; LDL, low-density lipoproteins; MDA, Mediterranean diet adherence; MR, mineralocorticoid receptor; MSH, melanocyte stimulating hormone; QUICKI, quantitative insulin sensitivity check index; TSH, thyroidstimulating hormone.
