Increased Neonatal Respiratory Morbidity Associated with Gestational and Pregestational Diabetes: A Retrospective Study

Abstract

Objective: To examine risk of neonatal respiratory morbidity associated with gestational and pregestational diabetes, accounting for the prematurity-associated risk using a propensity score analysis. Study design: In a retrospective study including 222,978 singleton pregnancies, delivering at 24 0/7–41 6/7 weeks (2002–2008), we calculated a probability to deliver at term (≥ 37 weeks’ gestation). Outcomes were stratified by the probability to deliver at term (>0.8 and ≤0.8). Adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) were calculated. Results: Gestational and pregestational diabetes complicated 5.1% and 1.5% of pregnancies, respectively and were associated with increased risks of neonatal respiratory morbidity compared to women without diabetes regardless of probability to deliver at term, although the risks tended to be higher with a higher probability to deliver at term: respiratory distress syndrome: aOR 1.5; 95%CI 1.3–1.7 and aOR 3.1; 95%CI 2.6–3.7; transient tachypnea of newborn aOR 1.5; 95%CI 1.3–1.6, and aOR 2.2; 95%CI 1.9–2.6; and apnea aOR 1.5; 95%CI 1.2–1.7 and aOR 3.2; 95%CI 2.6–3.9, for gestational and pregestational at term, respectively. Conclusion: Diabetes was associated with increased risk of neonatal respiratory morbidity beyond what can be attributed to prematurity. Neonatal respiratory morbidities were increased with pregestational compared with gestational diabetes.

The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

“…All studies were categorized as high quality [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ]. A total of 95.9% studies were prospective or retrospective cohorts [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , …”

“…In addition, 34.69% of the studies were conducted in the U.S. [ 22 , 24 , 25 , 31 , 33 , 34 , 36 , 37 , 38 , 41 , 44 , 52 , 53 , 55 , 57 , 58 , 64 ], 14.2% in Australia [ 20 , 27 , 28 , 50 , 51 , 65 , 68 ], 28.5% in Asia [ 26 , 29 , 32 , 35 , 39 , 40 , 42 , 46 , 47 , 48 , 49 , 60 , 63 , 66 ], and 22.4% in Europe [ 21 , 23 , 30 , 43 , 45 , 54 , 56 , 59 , 61 , 62 , 67 ].…”

“…A total of 95.9% studies were prospective or retrospective cohorts and 4% were cross-sectional studies [20,21]. In addition, 17 (34.6%) studies used the GDM classification of group 1 [21,22,26,35,38,40,47,48,50,51,53,54,[59][60][61]64,67] and IADPSG; 7 (14.2%) group 2 [20,27,28,51,59,65,68], 3 (6.1%) group 3 [32,46,56], 1 (2%) group 4 [51], 19 (38.7%) group 5 [23][24][25]29,31,33,34,36,39,40,42,44,47,53,55,57,58,64,66], 6 (12.2%) group 6…”

Patterns of antenatal corticosteroid administration in a cohort of women with diabetes in pregnancy

“…Elective caesarean section at less than 39 weeks' gestation is associated with an increase in the rate of neonatal respiratory complications [36,37] and infants born to mothers with DIP are at increased risk of respiratory morbidity compared to those born to mothers without DIP [8]. A systematic review of ANC administration prior to elective caesarean section at term reported a decrease in the risk of respiratory distress syndrome, transient tachypnoea of the newborn, admission to the neonatal intensive care unit for respiratory morbidity compared to placebo [38].…”

“…Women with pre-existing diabetes [4] and gestational diabetes [4,5] are more likely than women without diabetes to receive ANC, but it is not clear if this is due to the increased rate of preterm birth in women with DIP [6,7] or because their infants are more likely to develop complications of preterm birth [8], or both.…”