Neonatal outcomes of very low birthweight infants born to mothers with hyperglycaemia in pregnancy: a retrospective cohort study in Japan

Abstract

ObjectiveTo examine the mortality and morbidities of very low birthweight (VLBW, <1500 g) infants of mothers with hyperglycaemia in pregnancy.Design and settingWe conducted a retrospective cohort study using data from the Neonatal Research Network of Japan, a nationwide registry of VLBW infants (2003–2012).PatientsWe studied 29 626 infants born at 23 to 32 weeks without major congenital anomalies, of which 682 (2.3%) infants were from pregnancies affected by maternal hyperglycaemia.Main outcome measuresThe primary outcome was hospital mortality. Secondary outcomes were neonatal morbidities and their anthropometric values. Associations between maternal hyperglycaemia and each outcome were observed for the overall period, and statistical tests for interaction were conducted to assess whether they differed before or after the adoption of the International Association of Diabetes in Pregnancy Study Group (IADPSG) guidelines in 2010 for the diagnosis of gestational diabetes mellitus.ResultsOverall, hospital mortality (4.1% vs 5.2%), composite outcomes of mortality and severe morbidity (54.2% vs 60%), and anthropometric values were not significantly different between infants of mothers with or without hyperglycaemia in pregnancy. However, the incidence of respiratory distress syndrome (RDS) in VLBW infants from mothers with hyperglycaemia was significantly higher than those from mothers without it only before (relative risk (RR) 1.09, 95% CI 1.00 to 1.19) and not after (RR 0.97, 95% CI 0.83 to 1.11) the adoption of the IADPSG guidelines.ConclusionVLBW infants born to mothers with hyperglycaemia in pregnancy do not seem to be at higher risk of mortality and morbidities, except for RDS only before the adoption of the IADPSG guidelines.

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

“…Hitaka et al evaluated very low birth weight (VLBW) (<1500 gr) infants in Japan and showed that mortality and morbidity were not significantly different between infants of mothers with or without hyperglycinemia in pregnancy [ 189 ]. When 682 infants of mothers with hyperglycemia were compared to 28,944 infants of normoglycemic mothers, there was no statistical difference in the rate of necrotizing enterocolitis (NEC) ( p = 0.67), patent ductus arteriosus (PDA) ( p = 0.52), severe intraventricular hemorrhage (IVH), or periventricular leukomalacia (PVL) ( p = 0.27) and retinopathy of prematurity (ROP) ( p = 0.27).…”

“…In the year 2010, the criteria for hyperglycemia were changed so that the frequency of GDM pregnancies increased twofold to fourfold to 6–12%. The increased risk of RDS observed only in infants of mothers with hyperglycemia in pregnancy diagnosed before the relaxation of the GDM diagnostic criteria reflects the severity of maternal hyperglycemia in that time period [ 189 ]. Grandi et al evaluated the outcome of VLBW infants of diabetic mothers (both GDM and PGDM) from the NEOCOSUR South American Network (Argentina, Brazil, Chile, Paraguay, Peru, and Uruguay) [ 190 ].…”

“…Well-treated diabetes in pregnancy had a shoulder dystocia rate similar to controls. Hitaka et al [189] Grandi et al [190] Opara et al [191] Tunay et al [192] Diabetes in pregnancy increases the prematurity rate. The association between maternal diabetes and morbidities associated with prematurity vary between studies: no association [142,167], respiratory distress syndrome [189], necrotizing enterocolitis [158,190], late-onset sepsis [158], retinopathy of prematurity [158,191,192].…”

Systemic Cytokines in Retinopathy of Prematurity

“…Some researchers have reported maternal DM as a risk factor for ROP development [ 236 , 237 , 238 ], while others claimed no relationship [ 239 , 240 , 241 ]. One recent meta-analysis showed no association between maternal DM and ROP [ 242 ], but the heterogeneity among studies in terms of baseline subject characteristics and diabetes management may be overlooked.…”

Risk factor analyses for intraventricular hemorrhage in preterm infants: A retrospective cohort study

“…This process ensures the database is up-to-date and, therefore, useful for neonatal research studies. [7][8][9][10][11][12][13][14] We used data on VLBW infants born between January 2003 and December 2012, mainly from level-3 perinatal centers that were documented in the NRNJ database (N = 40,806). The list of 204 participating centers has already been published.…”