Impact of Maternal Diabetes Mellitus on Mortality and Morbidity of Preterm Infants (24–33 Weeks' Gestation)

Abstract

Data from several epidemiologic studies have demonstrated that diabetes mellitus (DM) is a risk factor for respiratory distress syndrome (RDS). Two previous studies have shown that with modern management and adequate glycemic control, the risk of RDS in near-term and term newborns of mothers with DM is not increased beyond that observed in a nondiabetic control population. Both these studies were limited by small numbers of preterm infants, and it remains unclear whether preterm infants of diabetic mothers are at increased risk for RDS. This study tested the hypothesis that maternal DM among a population of very low birth weight (VLBW) infants is associated with increased risk for mortality, RDS, and major complications of prematurity. Prospective data collected between 1995 and 2007 by the Israel Neonatal Network on VLBW Infants were analyzed with multivariable logistic regression analysis to assess the independent effect of maternal DM status (pregestational and gestational) on infant mortality, RDS, and other complications of prematurity. Because rates of major neonatal complications were very similar among infants of mothers with pregestational (n = 120) and gestational (n = 825) diabetes, their data were pooled. There was a greater likelihood that mothers with DM had received a complete course of prenatal steroids than nondiabetic mothers. Both the gestational age and birth weight were slightly increased in infants of diabetic mothers compared with infants of nondiabetic mothers. A nearly identical distribution of birth weight percentiles and mean birth weight z scores were found in both groups. Apgar scores were significantly higher among infants of diabetic mothers. With multivariate analysis, no significant differences between the 2 groups occurred in delivery room mortality, RDS, and other major complications of prematurity. Rates of total mortality and bronchopulmonary dysplasia were significantly higher among infants of nondiabetic mothers. No significant increases occurred in infants of diabetic mothers in the adjusted odds ratios for mortality, RDS, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, and patent ductus arteriosus. These findings indicate that with modern management and adequate prenatal care, VLBW infants of diabetic mothers are at no higher risk of developing RDS or other major complications of prematurity than infants of nondiabetic mothers.