992: The association between gestational diabetes mellitus and neonatal respiratory morbidity

Abstract

Contemporary management of gestational diabetes mellitus (GDM) focuses on aggressive control of maternal blood glucose, in part to minimize the likelihood of neonatal respiratory morbidity. Therefore, we sought to assess neonatal respiratory morbidity in pregnancies with and without GDM at imminent risk of late preterm delivery in a modern US cohort. Secondary analysis of a large randomized placebo-controlled trial in which women with singleton pregnancies at high risk for delivery between 34 0/7 and 36 5/7 weeks’ gestation were allocated to betamethasone or placebo. The primary outcome for the trial and this secondary analysis was the need for respiratory support in the first 72 hours of life; we had 80% power to detect a 38% difference in this outcome between neonates born to women with, and without, GDM. Secondary outcomes included neonatal severe respiratory complications, neonatal intensive care unit (NICU) admission >/= 3 days, and hyperbilirubinemia. We examined associations between neonatal morbidities and GDM status after adjustment for baseline differences and study group allocation using Modified Poisson Regression. Women with GDM were significantly older, more likely to be parous and to have hypertensive disorders of pregnancy than those without GDM, but were similar with regard to race, gestational age at enrollment and at delivery (36.1 weeks), and study group assignment. Neonates born to women with GDM were no more likely to meet the primary outcome than those without GDM (12.1% v. 13.1%) nor were they more likely to have severe respiratory complications or prolonged NICU admission. They were, however, more likely to have hyperbilirubinemia even after adjustment for age, parity and hypertension (Table). Models incorporating a product interaction term between GDM status and treatment arm (antenatal steroids or placebo) did not significantly affect the findings. GDM is not associated with increased neonatal respiratory morbidity irrespective of antenatal steroid administration.