998: Association between labor and neonatal respiratory morbidity in pregnancies complicated by gestational diabetes mellitus

Abstract

Neonates born to women with gestational diabetes mellitus (GDM) have historically been thought to be at increased risk of respiratory morbidity but it is uncertain whether or how exposure to labor affects this association. Therefore, we sought to assess the risk of respiratory complications in neonates who were delivered after labor compared to those who did not experience labor among a cohort of neonates born to women with GDM. A prospective cohort study of singleton pregnancies complicated by GDM in which the infants were live born at ≥34 weeks. The primary outcome for this analysis was respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN) which resulted in neonatal intensive care unit (NICU) admission. Neonates who experienced labor (either spontaneous or induced) were compared to those who delivered by cesarean without labor. Covariates, including gestational age, were investigated and adjusted for if the p-value was <0.05. Of the 292 neonates meeting study inclusion criteria, 25 (8.6%) developed RDS or TTN and required NICU admission (median length of stay = 7 days). Seventy four delivered without labor (25 by primary cesarean delivery [CD] and 49 by repeat CD) and 218 delivered after labor (46 by CD and 172 vaginally). Those who delivered without labor and those who labored delivered at similar gestational ages (38.4 v. 38.6 weeks), but differed with regard to age and race. Not laboring, compared to laboring, was associated with a significantly higher risk of the primary outcome, 13.5% v. 4.1% (OR 3.6; 95% CI 1.4-9.3). Even after adjusting for age and race, those who did not labor had a higher risk of the primary outcome (aOR 4.2; 95% CI 1.2-14.9). Exposure to labor is associated with a decreased risk of respiratory morbidity in neonates born in the late preterm or term period to mothers with GDM.