Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study

Abstract

Objectives: To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). Methods: This was a cohort study with retrospective data collection (2001 ---2010, n = 11.991) from the Neocosur network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. Results: The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p = 0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) DOI se refere ao artigo: http://dx.Very low birth weight infants of diabetic mothers 235 was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). Conclusions: VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC. Impacto da diabetes mellitus maternal sobre a mortalidade e morbidade de crianças com muito baixo peso ao nascer: um estudo em diversos centros da América Latina ResumoObjetivos: Comparar mortalidade e morbidade em crianças de muito baixo peso (MBP) filhas de mães com e sem diabetes mellitus (DM). Métodos: Estudo de coorte com coleta retrospectiva de dados (2001-2010, n = 11.991) da rede Neocosur. Odds ratios ajustados foram calculados para mortalidade e morbilidade neonatal em função da DM materna. Mulheres sem DM serviram como grupo de referência. Resultados: A taxa de DM materna foi de 2,8% (IC 95% 2,5-3,1), mas um aumento significativo (p = 0,019) entre 2001-2005 (2,4%) e 2006-2010 (3,2%) foi observado. As mães com DM eram mais propensas a ter recebido um curso completo de esteroides pré-natais do que as sem DM. Os bebês de mães diabéticas tinham uma idade gestacional e peso ao nascer um pouco maior do que crianças filhas de não DM. A distribuição dos escores z do peso ao nascer, pequeno para idade gestacional e de Apgar foi semelhante. Não houve diferenças significativas entre os dois grupos em termos de síndrome do desconforto respiratório, displasia broncopulmonar, hemorragia intraventricular, leucomalácia periventricular e pe...

Outcomes of Extremely Preterm Infants Born to Insulin-Dependent Diabetic Mothers

“…The authors reported increased risk only for NEC (RR = 1.65, 95% CI: 1.21-2.27). 8 A third descriptive study of 43 VLBW infants of diabetic women (gestational and pregestational) showed no differences in hospital morbidities or neurodevelopmental outcomes at 18 months compared with controls. 9 None of these studies examined glycemic control method.…”

“…[7][8][9] One study in Israel combined VLBW infants of mothers with gestational (n = 825) and pregestational diabetes (n = 120) into 1 group after finding no differences in demographic and delivery characteristics and reported no increased risks in hospital mortality or morbidities compared with VLBW infants of nondiabetic mothers (n = 12 209). 7 Another study in Latin America with no information on diabetes type examined in-hospital morbidities between VLBW infants of mothers with any type of diabetes (n = 304) and VLBW infants of mothers without diabetes (n = 10 563).…”

“…[3][4][5][6] Few studies have examined the resulting complications and neurodevelopmental outcomes among extremely preterm infants born to diabetic mothers, and none has examined the impact of glycemic control mode on infant outcomes. [7][8][9] With the increasing incidence of both gestational and pregestational diabetes 10 and the high incidence of preterm birth associated with diabetes, it is imperative to examine outcomes in this high-risk group of infants.…”

Assesment of Prenatal Distress and Depressive Symptoms in Women with Gestational Diabetes

“…Diabetes Mellitus affects approximately 0.6 to 15% of women all over the world (4)(5)(6). Gestational diabetes is defined as carbohydrate intolerance (7)(8)(9). In Turkey, the prevalence of GDM has been found between 1.2%-30.8% (10,11).…”

Inclusão do parceiro na assistência pré-natal

“…Sabe-se que HAS é a principal causa de mortalidade materna em todo o país, representando um grave problema de saúde pública 49 . As complicações advindas da HAS, tais como a pré-eclâmpsia e a eclâmpsia, contribuem decisivamente para desfechos desfavoráveis 63,64 .…”