APGAR scores are lower in offspring from mothers with type 1 diabetes – results from the BABY DIAB study

Abstract

Infants born to women with type 1 diabetes (T1D) are at increased risk of neonatal morbidity. Intrapartum monitoring is therefore essential to minimize complications. We analyzed APGAR scores after 5 and 10min. in BABYDIAB offspring from mothers with T1D (n=1047) compared to offspring from non-diabetic mothers whose partners had T1D (n=592). Sectio rates in mothers with T1D were increased more than two-fold (48.1%) compared to mothers w/o T1D (21.4%, p<0.0001). 16 of 927 offspring (1.7%) suffered from initial asphyxia as defined by an APGAR (5') <7. Neonates from mothers with T1D had lower mean APGAR scores compared to offspring from non-diabetic mothers (p<0.0001). Translated into clinical practice, that was a lower rate of maximally good APGAR scoring of 10 (47%) in children from mothers with T1D compared with offspring from non-diabetic mothers (71.8%, p<0.0001) while rates of early asphyxia were not different (1.9% vs. 1.7%). Since mean APGAR scores were decreased in offspring delivered by sectio compared with neonates born spontaneously (p<0.0001), APGAR scores by maternal diabetes status were controlled for the mode of delivery. Again, rates of low APGAR 5' scores were higher and rates of maximally good scores lower both in offspring from diabetic mothers delivered by sectio and in children born spontaneously compared to offspring from non-diabetic mothers (p<0.034, p<0.0001). HbA1c levels at delivery were slightly higher in mothers who gave birth by sectio (5.86%) compared to mothers who delivered spontaneously (5.69%, p<0.035). Mean APGAR5'scores were also lower in offspring from mothers with elevated HbA1c levels when comparing HbA1c-subgroups defined by an HbA1c >8% vs. 7–8% vs. 6–7% vs. 5–6%, p<0.007, Kruskal-Wallis). In conclusion, offspring of mothers with well controlled T1D may not be at risk of severely compromised vitality at birth, however, they less often score maximum points on the APGAR scale compared to offspring from non-diabetic mothers.