Gestational diabetes: a strong independent risk factor for severe neonatal respiratory failure after 34 weeks
- 547 Downloads
To evaluate if gestational diabetes (GD) exposes neonates delivered after 34 weeks to an increased risk of severe neonatal respiratory failure (NRF).
Data from 3,237 women who delivered after 34 weeks with systematic screening for GD were analyzed. Diagnosis of severe NRF required the association of clinical and radiological criteria with a minimum of 24 h of ventilation and admission to neonatal intensive care unit.
A total of 166 (5.1%) cases of GD were identified. Severe NRF was diagnosed in 7 (4.21%) cases among women with GD as compared to 13 (0.42%) in others (p < 0.001). The rate of severe NRF was also significantly higher in cases of premature delivery (p < 0.001), fetal growth retardation (p < 0.001), and cesarean section (p = 0.005). After adjustment for these variables, GD was identified as an independent risk factor for NRF (AOR 11.55, 95% CI 3.9–33.9, p < 0.001). Two other risk factors were also identified: late preterm delivery (AOR 6.13, 95% CI 1.8–21.2, p = 0.004); and hypotrophy (AOR 9.16, 95% CI 2.7–30.5, p < 0.001).
GD is an independent risk factor for severe NRF after 34 weeks. Neonates from such pregnancies should be monitored carefully.
KeywordsDiabetes mellitus Gestational diabetes Neonatal respiratory failure Ventilation Late preterm delivery
Funding source none.
Conflict of interest
All authors have no conflict of interest to declare.
- 1.American Diabetes Association (2004) Diabetes care 27(S1):S88–90Google Scholar
- 9.Kjos SL, Walther FJ, Montoro M, Paul RH, Diaz F, Stabler M (1990) Prevalence and etiology of respiratory distress in infants of diabetic mothers: predictive value of fetal lung maturation tests. Am J Obstet Gyn 163:898–903Google Scholar
- 13.Wilmink FA, Hukkelhoven CW, Lunshof S, Mol BW, van der Post JA, Papatsonis DN (2010) Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. Am J Obstet Gyn 202:250 e1–8Google Scholar
- 14.Melamed N, Ben-Haroush A, Pardo J, Chen R, Hadar E, Hod M et al (2010) Expectant management of preterm premature rupture of membranes: is it all about gestational age? Am J Obstet Gyn (in press)Google Scholar
- 15.Mimouni F, Miodovnik M, Whitsett JA, Holroyde JC, Siddiqi TA, Tsang RC (1987) Respiratory distress syndrome in infants of diabetic mothers in the 1980 s: no direct adverse effect of maternal diabetes with modern management. Obstet Gyn 69:191–195Google Scholar
- 18.Hawkins JS, Casey BM, Lo JY, Moss K, McIntire DD, Leveno KJ (2009) Weekly compared with daily blood glucose monitoring in women with diet-treated gestational diabetes. Obstet Gyn 113:1307–1312Google Scholar