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Association between Respiratory Morbidity and Labor in Pregnancies with Gestational Diabetes Mellitus.
Am J Perinatol. 2020 Sep 06 [Online ahead of print]AJ

Abstract

OBJECTIVE

This study aimed to the assess risk of respiratory morbidity in neonates born to women with gestational diabetes mellitus (GDM) delivered after labor compared with those delivered without exposure to labor.

STUDY DESIGN

This is a secondary analysis of a prospective single-center cohort study of singleton pregnancies complicated by GDM. Neonates who were liveborn and delivered at ≥34 weeks' gestation were included. The primary outcome was respiratory morbidity defined as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN) resulting in neonatal intensive care unit (NICU) admission. Neonates born after labor (either spontaneous or induced) were compared with those delivered by cesarean delivery without labor. Associations between labor and neonatal morbidities were estimated using logistic regression. Covariates were adjusted for if they differed significantly between neonates exposed to and not exposed to labor (p < 0.05) and there was biologic plausibility that they would affect neonatal respiratory morbidity.

RESULTS

Of the 581 neonates meeting study inclusion criteria, 23.2% delivered without exposure to labor. Those who did and did not experience labor delivered at similar gestational ages (38.6 vs. 38.4 weeks). Thirty-six neonates (6.2%) developed RDS or TTN and were admitted to the NICU. Exposure to labor was associated with a lower frequency of respiratory morbidity requiring admission to NICU, 4.9% (22/446) versus 10.4% (14/135) (p = 0.04). After adjusting for parity, body mass index, birth weight, gestational weight gain more than Institute of Medicine guidelines, race, and exposure to labor were associated with an adjusted odds ratio of 0.41 (95% confidence interval: 0.18-0.89).

CONCLUSION

Exposure to labor was associated with decreased odds of respiratory morbidity in neonates born to mothers with GDM. Limiting elective cesarean in this population can reduce health care costs and optimize neonatal health.

KEY POINTS

· Labor is associated with less respiratory morbidity.. · We should limit elective cesarean delivery with GDM.. · This approach could reduce health care costs..

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island. Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island.Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island. Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island.Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island.Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32892330

Citation

Yu, Hope Y., et al. "Association Between Respiratory Morbidity and Labor in Pregnancies With Gestational Diabetes Mellitus." American Journal of Perinatology, 2020.
Yu HY, Has P, Clark MA, et al. Association between Respiratory Morbidity and Labor in Pregnancies with Gestational Diabetes Mellitus. Am J Perinatol. 2020.
Yu, H. Y., Has, P., Clark, M. A., Esposito, M., Rouse, D. J., & Werner, E. F. (2020). Association between Respiratory Morbidity and Labor in Pregnancies with Gestational Diabetes Mellitus. American Journal of Perinatology. https://doi.org/10.1055/s-0040-1716483
Yu HY, et al. Association Between Respiratory Morbidity and Labor in Pregnancies With Gestational Diabetes Mellitus. Am J Perinatol. 2020 Sep 6; PubMed PMID: 32892330.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between Respiratory Morbidity and Labor in Pregnancies with Gestational Diabetes Mellitus. AU - Yu,Hope Y, AU - Has,Phinnara, AU - Clark,Melissa A, AU - Esposito,Matthew, AU - Rouse,Dwight J, AU - Werner,Erika F, Y1 - 2020/09/06/ PY - 2020/9/6/entrez PY - 2020/9/7/pubmed PY - 2020/9/7/medline JF - American journal of perinatology JO - Am J Perinatol N2 - OBJECTIVE: This study aimed to the assess risk of respiratory morbidity in neonates born to women with gestational diabetes mellitus (GDM) delivered after labor compared with those delivered without exposure to labor. STUDY DESIGN: This is a secondary analysis of a prospective single-center cohort study of singleton pregnancies complicated by GDM. Neonates who were liveborn and delivered at ≥34 weeks' gestation were included. The primary outcome was respiratory morbidity defined as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN) resulting in neonatal intensive care unit (NICU) admission. Neonates born after labor (either spontaneous or induced) were compared with those delivered by cesarean delivery without labor. Associations between labor and neonatal morbidities were estimated using logistic regression. Covariates were adjusted for if they differed significantly between neonates exposed to and not exposed to labor (p < 0.05) and there was biologic plausibility that they would affect neonatal respiratory morbidity. RESULTS: Of the 581 neonates meeting study inclusion criteria, 23.2% delivered without exposure to labor. Those who did and did not experience labor delivered at similar gestational ages (38.6 vs. 38.4 weeks). Thirty-six neonates (6.2%) developed RDS or TTN and were admitted to the NICU. Exposure to labor was associated with a lower frequency of respiratory morbidity requiring admission to NICU, 4.9% (22/446) versus 10.4% (14/135) (p = 0.04). After adjusting for parity, body mass index, birth weight, gestational weight gain more than Institute of Medicine guidelines, race, and exposure to labor were associated with an adjusted odds ratio of 0.41 (95% confidence interval: 0.18-0.89). CONCLUSION: Exposure to labor was associated with decreased odds of respiratory morbidity in neonates born to mothers with GDM. Limiting elective cesarean in this population can reduce health care costs and optimize neonatal health. KEY POINTS: · Labor is associated with less respiratory morbidity.. · We should limit elective cesarean delivery with GDM.. · This approach could reduce health care costs.. SN - 1098-8785 UR - https://www.unboundmedicine.com/medline/citation/32892330/Association_between_Respiratory_Morbidity_and_Labor_in_Pregnancies_with_Gestational_Diabetes_Mellitus_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0040-1716483 DB - PRIME DP - Unbound Medicine ER -
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