Background: Adipokines, peptides produced mainly by adipose tissue, in addition to peptides produced from the digestive tract, play critical roles in energy homeostasis and metabolic regulation. Leptin and ghrelin seem to play an important role in the regulation of food intake and body weight. Both originate in the periphery and signal through different pathways to the brain, particularly to the hypothalamus. Ghrelin may play a role in determining adaptations of the fetus to an adverse intrauterine environment. Leptin is responsible for weight and fat regulation in utero. It regulates intrauterine and early extrauterine life growth and development as well as the adaptation to extrauterine life.Objective: It is a cross-sectional study aimed to assess umbilical ghrelin level in full term, preterm and infant of diabetic mother and to evaluate whether ghrelin levels were modulated by leptin, insulin and glucose levels and their association with anthropometric measures. Subjects and Methods: It was conducted on 99 neonates 43 full term appropriate (AGA) and small (SGA) for gestational age, 43 preterm (AGA and SGA), 13 IDM in the delivery room in Obstetrics and Gynecology Hospital, Cairo University. For all subjects, anthropometric measurements were assessed and laboratory investigations in the form of ghrelin (total, active), leptin, insulin by ELISA technique and glucose in the newborn cord blood. Results: There was significant positive correlation between cord ghrelin and the different anthropometric parameters (weight (WT), length (L) and head circumference (HC)) in preterm AGA groups ((r=0.407, p=0.021) (r=0.461, p=0.031), and (r=0.473, p = 0.026) respectively). A negative correlation was detected with active ghrelin and the different anthropometric parameters (WT, L, and HC) and leptin in full term SGA group ((r= -0.753, p=0.005), (r= -0.625, p= 0.030), (r= -0.807, p=0.002), and (r=-0.776, p= 0.003) respectively), whereas, there was positive correlation between active ghrelin and both of the WT, and L in full term AGA group ((r=0.523, p= 0.018), (r= 0.354, p=0.031, respectively). In preterm SGA group, there was negative correlation between active ghrelin and each of gestational age (GA), WT and L (r=-0.210, p= 0.047), (r=-0.266,p= 0.023), and (r=-0.254,p= 0.006) respectively). A significant correlation between leptin and each of GA, WT, and L in preterm SGA neonates ((r=0.102, p= 0.044), (r = 0.418, p = 0.038), and (r=0.555, p=0.004) respectively). A significant negative relation between total ghrelin and both of insulin and HOMAin full term AGA ((r=-0.489, p=0.013), and (r=-0.461, p= 0.020) respectively). A significant negative correlation between total ghrelin and both of leptin and glucose in preterm SGA (r=-0.330, p=0.002) and (r= -0 393, p= 0.017, respectively). Conclusion: Cord active ghrelin concentrations in the SGA infants were significantly greater than those in the AGA infants, and they were negatively correlated with birth weight and BMI. These findings suggest that active ghrelin is involved in energy homeostasis and is affected by nutritional status also in intrauterine life. Also, our study is the first to demonstrate significantly higher circulating active ghrelin levels in preterm SGA infants and to report the negative correlation of active ghrelin with birth weight in the preterm infant population.