540: Early term delivery: Is there a difference in neonatal respiratory morbidity by diabetes sub-type?

Abstract

Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) have been linked to biochemical evidence of delayed fetal lung maturation and neonatal respiratory morbidity in the late preterm period. We sought to compare the impact of diabetes sub-types on neonatal respiratory outcomes in the early term period. We performed a retrospective cohort study of all pregnancies complicated by T2DM or GDM from 2009-2017 and delivered in the early term period (37 0/7-38 6/7 weeks gestation) at an academic tertiary care center. Those with multiple gestations, fetal anomalies, chorioamnionitis, and receipt of antenatal corticosteroids during were excluded. The primary outcome was composite neonatal respiratory morbidity, which included respiratory distress syndrome (RDS) and neonatal respiratory support. Univariable analyses were performed to compare maternal demographics between those with T2DM and GDM. A multivariable logistic regression analysis was performed to adjust for potential confounders, including maternal age, body mass index, chronic hypertension, and race. A total of 683 patients were included in the study, 382 (56%) with GDM and 301 (44%) with T2DM. Women with GDM and T2DM had similar demographic characteristics except those with T2DM were more likely to have chronic hypertension (59% vs. 31%; p< 0.01). Women with T2DM had a significantly increased risk of both composite neonatal respiratory morbidity (aRR 1.49; 95% confidence interval 1.17-1.89) and neonatal RDS alone (aRR 1.63; 95% CI 1.15-2.30) (Table 1). There is a 1.5-fold increased risk for neonatal respiratory morbidity among infants born to women with T2DM compared GDM in the early term period.