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Association of Maternal Diabetes With Neonatal Outcomes of Very Preterm and Very Low-Birth-Weight Infants: An International Cohort Study.
JAMA Pediatr. 2018 09 01; 172(9):867-875.JP

Abstract

Importance

Diabetes in pregnancy is associated with a 2-times to 3-times higher rate of very preterm birth than in women without diabetes. Very preterm infants are at high risk of death and severe morbidity. The association of maternal diabetes with these risks is unclear.

Objective

To determine the associations between maternal diabetes and in-hospital mortality, as well as neonatal morbidity in very preterm infants with a birth weight of less than 1500 g.

Design, Setting, Participants

This retrospective cohort study was conducted at 7 national networks in high-income countries that are part of the International Neonatal Network for Evaluating Outcomes in Neonates and used prospectively collected data on 76 360 very preterm, singleton infants without malformations born between January 1, 2007, and December 31, 2015, at 24 to 31 weeks' gestation with birth weights of less than 1500 g, 3280 (4.3%) of whom were born to diabetic mothers.

Exposures

Any type of diabetes during pregnancy.

Main Outcomes and Measures

The primary outcome was in-hospital mortality. The secondary outcomes were severe neonatal morbidities, including intraventricular hemorrhages of grade 3 to 4, cystic periventricular leukomalacia, retinopathy of prematurity needing treatment and bronchopulmonary dysplasia, and other morbidities, including respiratory distress, treated patent ductus arteriosus, and necrotizing enterocolitis. Odds ratios (ORs) with 95% confidence intervals were estimated, adjusted for potential confounders, and stratified by gestational age (GA), sex, and network.

Results

The mean (SD) birth weight of offspring born to mothers with diabetes was significantly higher at 1081 (262) g than in offspring born to mothers without diabetes (mean [SD] birth weight, 1027 [270] g). Mothers with diabetes were older and had more hypertensive disorders, antenatal steroid treatments, and deliveries by cesarean delivery than mothers without diabetes. Infants of mothers with diabetes were born at a later GA than infants of mothers without diabetes. In-hospital mortality (6.6% vs 8.3%) and the composite of mortality and severe morbidity (31.6% vs 40.6%) were lower in infants of mothers with diabetes. However, in adjusted analyses, no significant differences in in-hospital mortality (adjusted OR, 1.16 (95% CI, 0.97-1.39) or the composite of mortality and severe morbidity (adjusted OR, 0.99 (95% CI, 0.88-1.10) were observed. With few exceptions, outcomes of infants born to mothers with and without diabetes were similar regardless of infant sex, GA, or country of birth.

Conclusions and Relevance

In high-resource settings, maternal diabetes is not associated with an increased risk of in-hospital mortality or severe morbidity in very preterm infants with a birth weight of fewer than 1500 g.

Authors+Show Affiliations

Department of Medicine, Clinical Epidemiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada. Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.Unit of Epidemiology Meyer Children's University Hospital and Regional Health Agency, Florence, Italy.Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster campus, London, England.Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan.Turku University Hospital and University of Turku, Finland.Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden.Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan.Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada. Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada.Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada. Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29971428

Citation

Persson, Martina, et al. "Association of Maternal Diabetes With Neonatal Outcomes of Very Preterm and Very Low-Birth-Weight Infants: an International Cohort Study." JAMA Pediatrics, vol. 172, no. 9, 2018, pp. 867-875.
Persson M, Shah PS, Rusconi F, et al. Association of Maternal Diabetes With Neonatal Outcomes of Very Preterm and Very Low-Birth-Weight Infants: An International Cohort Study. JAMA Pediatr. 2018;172(9):867-875.
Persson, M., Shah, P. S., Rusconi, F., Reichman, B., Modi, N., Kusuda, S., Lehtonen, L., Håkansson, S., Yang, J., Isayama, T., Beltempo, M., Lee, S., & Norman, M. (2018). Association of Maternal Diabetes With Neonatal Outcomes of Very Preterm and Very Low-Birth-Weight Infants: An International Cohort Study. JAMA Pediatrics, 172(9), 867-875. https://doi.org/10.1001/jamapediatrics.2018.1811
Persson M, et al. Association of Maternal Diabetes With Neonatal Outcomes of Very Preterm and Very Low-Birth-Weight Infants: an International Cohort Study. JAMA Pediatr. 2018 09 1;172(9):867-875. PubMed PMID: 29971428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Maternal Diabetes With Neonatal Outcomes of Very Preterm and Very Low-Birth-Weight Infants: An International Cohort Study. AU - Persson,Martina, AU - Shah,Prakesh S, AU - Rusconi,Franca, AU - Reichman,Brian, AU - Modi,Neena, AU - Kusuda,Satoshi, AU - Lehtonen,Liisa, AU - Håkansson,Stellan, AU - Yang,Junmin, AU - Isayama,Tetsuya, AU - Beltempo,Marc, AU - Lee,Shoo, AU - Norman,Mikael, AU - ,, PY - 2018/7/5/pubmed PY - 2019/10/9/medline PY - 2018/7/5/entrez SP - 867 EP - 875 JF - JAMA pediatrics JO - JAMA Pediatr VL - 172 IS - 9 N2 - Importance: Diabetes in pregnancy is associated with a 2-times to 3-times higher rate of very preterm birth than in women without diabetes. Very preterm infants are at high risk of death and severe morbidity. The association of maternal diabetes with these risks is unclear. Objective: To determine the associations between maternal diabetes and in-hospital mortality, as well as neonatal morbidity in very preterm infants with a birth weight of less than 1500 g. Design, Setting, Participants: This retrospective cohort study was conducted at 7 national networks in high-income countries that are part of the International Neonatal Network for Evaluating Outcomes in Neonates and used prospectively collected data on 76 360 very preterm, singleton infants without malformations born between January 1, 2007, and December 31, 2015, at 24 to 31 weeks' gestation with birth weights of less than 1500 g, 3280 (4.3%) of whom were born to diabetic mothers. Exposures: Any type of diabetes during pregnancy. Main Outcomes and Measures: The primary outcome was in-hospital mortality. The secondary outcomes were severe neonatal morbidities, including intraventricular hemorrhages of grade 3 to 4, cystic periventricular leukomalacia, retinopathy of prematurity needing treatment and bronchopulmonary dysplasia, and other morbidities, including respiratory distress, treated patent ductus arteriosus, and necrotizing enterocolitis. Odds ratios (ORs) with 95% confidence intervals were estimated, adjusted for potential confounders, and stratified by gestational age (GA), sex, and network. Results: The mean (SD) birth weight of offspring born to mothers with diabetes was significantly higher at 1081 (262) g than in offspring born to mothers without diabetes (mean [SD] birth weight, 1027 [270] g). Mothers with diabetes were older and had more hypertensive disorders, antenatal steroid treatments, and deliveries by cesarean delivery than mothers without diabetes. Infants of mothers with diabetes were born at a later GA than infants of mothers without diabetes. In-hospital mortality (6.6% vs 8.3%) and the composite of mortality and severe morbidity (31.6% vs 40.6%) were lower in infants of mothers with diabetes. However, in adjusted analyses, no significant differences in in-hospital mortality (adjusted OR, 1.16 (95% CI, 0.97-1.39) or the composite of mortality and severe morbidity (adjusted OR, 0.99 (95% CI, 0.88-1.10) were observed. With few exceptions, outcomes of infants born to mothers with and without diabetes were similar regardless of infant sex, GA, or country of birth. Conclusions and Relevance: In high-resource settings, maternal diabetes is not associated with an increased risk of in-hospital mortality or severe morbidity in very preterm infants with a birth weight of fewer than 1500 g. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/29971428/Association_of_Maternal_Diabetes_With_Neonatal_Outcomes_of_Very_Preterm_and_Very_Low_Birth_Weight_Infants:_An_International_Cohort_Study_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.1811 DB - PRIME DP - Unbound Medicine ER -