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Globally, GDM affects up to 16%\u201317% of pregnancies, with higher prevalence in low\u2010 and middle\u2010income countries. Poorly controlled maternal hyperglycemia increases the risk of congenital malformations, intrauterine death, macrosomia, and metabolic disturbances, and contributes to long\u2010term vulnerabilities including obesity, type 2 diabetes, and cardiovascular disease in offspring. Beyond its metabolic consequences, GDM is increasingly recognized as a prenatal condition capable of shaping fetal developmental trajectories. Emerging evidence indicates that maternal hyperglycemia influences the maturation of the autonomic nervous system (ANS), with measurable effects on neonatal heart rate variability (HRV), a widely used non\u2010invasive proxy of autonomic function, although not a direct measure of sympathetic and parasympathetic activity. Findings from fetal magnetocardiography and neonatal electrocardiography show that exposure to GDM is associated with altered HRV profiles, such as sympathetic predominance, reduced autonomic flexibility, or atypical vagal modulation, depending on perinatal physiology. These patterns suggest that ANS dysregulation can originate in utero and persist into the early postnatal period. This educational review examines the biological and pathophysiological mechanisms linking maternal hyperglycemia to impaired ANS development in fetuses and newborns. Alongside epidemiological and clinical data on infants born to mothers with GDM, it synthesizes recent evidence positioning HRV as a potential early biomarker of autonomic dysregulation. Ultimately, GDM's influence extends beyond glycemic imbalance, affecting the neurobiological foundations of autonomic function and potentially identifying neonates at risk for later cardiometabolic complications.<\/jats:p>","DOI":"10.1111\/anec.70173","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T08:26:57Z","timestamp":1774686417000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Heart Rate Variability in Newborns From Diabetic Mothers: Clinical Application and Significance"],"prefix":"10.1111","volume":"31","author":[{"given":"Virginia","family":"Beretta","sequence":"first","affiliation":[{"name":"Neonatology Unit, Department of Medicine and Surgery, University of Parma Pietro Barilla Children's Hospital  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Cannav\u00f2","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit University Hospital of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiano","family":"Ravenda","sequence":"additional","affiliation":[{"name":"Stress Physiology Laboratory, Department of Chemistry Life Sciences and Environmental Sustainability \u2013 University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Petrolini","sequence":"additional","affiliation":[{"name":"Neonatology Unit, Department of Medicine and Surgery, University of Parma Pietro Barilla Children's Hospital  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Raitano","sequence":"additional","affiliation":[{"name":"Neonatology Unit, Department of Medicine and Surgery, University of Parma Pietro Barilla Children's Hospital  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Moretti","sequence":"additional","affiliation":[{"name":"Neonatology Unit, Department of Medicine and Surgery, University of Parma Pietro Barilla Children's Hospital  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Dell'Orto","sequence":"additional","affiliation":[{"name":"Neonatology Unit, Department of Medicine and Surgery, University of Parma Pietro Barilla Children's Hospital  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5478-5657","authenticated-orcid":false,"given":"Serafina","family":"Perrone","sequence":"additional","affiliation":[{"name":"Neonatology Unit, Department of Medicine and Surgery, University of Parma Pietro Barilla Children's Hospital  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines11061591"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/325851"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13020293"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.34763\/jmotherandchild.20222601.d\u201022\u201000040"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.2007.s103"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15\u2010S005"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc18\u2010S002"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.302.4396"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.311.6998.171"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892\u2010019\u20101267\u20106"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467\u2010010\u20101506\u20101"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2020.561186"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.18010"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19010583"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/2845352"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2023.103771"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhl.2003.6"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.14474"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0002\u20109378(87)80042\u2010x"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1590\/0103\u20100582201432215513"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2017.07.002"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707943"},{"key":"e_1_2_14_24_1","unstructured":"Hartling L. 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