A study recently reported in the journal “Pediatrics” has demonstrated that pregnant women with well-managed diabetes may not be at increased risk of giving birth to preterm infants or infants with very low birth weight.
“With modern management and adequate glycemic control in pregnancies complicated by diabetes mellitus, the risk of respiratory distress syndrome in near-term and term newborns may not be increased beyond that of a nondiabetic control population,” wrote the authors of the study. The investigation was headed by Yoram Bental M.D., with the Department of Neonatology at Laniado Hospital in Israel and the Israel Institute of Technology in Haifa; also affiliated were researchers with the Israel Neonatal Network. “We hypothesized that maternal …DM increases the risk for mortality, respiratory distress syndrome (RDS), and major complications of prematurity,” continued the authors.
The research team used data collected from the Israel National Very Low Birth Weight Infant Database, covering the years 1995 to 2007. Pregnant woman with diabetes were categorized as either pregestational or gestational; the independent effects of diabetes in pregnant women on infant mortality, RDS, and other complications related to premature birth were analyzed with multivariable logistic regression. The two groups of mothers — those with pregestational and gestational diabetes — demonstrated similar results so their data was pooled together in further analysis.
Mothers with diabetes were more likely to have received a complete course of prenatal steroids compared to women who had not been diagnosed with diabetes. The infants of diabetic mothers showed slightly higher gestational age and birth weight than those of non-diabetic women, but the two groups also demonstrated a similar distribution of birth weight percentiles and mean birth weight z scores. The group of diabetic mothers had higher Apgar scores, enough to be considered statistically significant.
The two groups of mothers did not have significantly different rates of delivery room mortality, RDS, and other complications associated with premature birth. In fact, the group of non-diabetic mothers had a significantly higher rate of total mortality and bronchopulmonary dysplasia. Among the mothers with diabetes, adjusted odds ratios were not significantly increased for risk of mortality, RDS, bronchopulmonary dysplasia, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosus, retinopathy of prematurity, or intraventricular hemorrhage.
“With modern management and adequate prenatal care, IDM born very low birthweight do not seem to be at an excess risk of developing RDS or other major complications of prematurity compared with non-IDM,” wrote the study authors.
Limitations in the study’s methodology that could potentially affect results include a lack of prospective recording of the degree of glycemic control or the type of diabetes with which the mothers had been diagnosed.
The study’s authors concluded that diabetes should not be considered as an extra risk factor in the development of RDS in infants. “Whenever financial limitations are important in the strategic planning of delivery room care of premature infants, and in particular if the issue of prophylactic surfactant is to be discussed, we suggest that IDM should not be considered as an extra risk of developing RDS,” wrote the authors. “This suggestion is probably strengthened from the fact that safe therapeutic alternatives to prophylactic surfactant exist, such as early nasal continuous positive airway pressure. However, this speculation has not been proved and may not be valid in cases of poor glycemic control.”
The Israel National Very Low Birth Weight Infant Database receives partial support from the Israel Center for Disease Control and the Ministry of Health.