Increased Neonatal Respiratory Morbidity Associated with Gestational and Pregestational Diabetes: A Retrospective Study

Abstract

Objective To examine the risk of neonatal respiratory morbidity associated with gestational and pregestational diabetes, accounting for the prematurity-associated risk using a propensity score analysis. Study design In a retrospective study including 222,978 singleton pregnancies, delivering at 240/7 to 416/7 weeks (2002–2008), we calculated a probability to deliver at term (≥37 weeks of gestation). Outcomes were stratified by the probability to deliver at term (>0.8 and ≤0.8). Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated. Results Gestational and pregestational diabetes complicated 5.1 and 1.5% of pregnancies, respectively, and were associated with increased risks of neonatal respiratory morbidity compared with women without diabetes regardless of probability to deliver at term. However, these risks tended to be higher with a higher probability to deliver at term: respiratory distress syndrome (aOR: 1.5; 95% CI: 1.3–1.7 and aOR: 3.1; 95% CI: 2.6–3.7); transient tachypnea of newborn (aOR: 1.5; 95% CI: 1.3–1.6 and aOR: 2.2; 95% CI: 1.9–2.6); and apnea (aOR: 1.5; 95% CI: 1.2–1.7 and aOR: 3.2; 95% CI: 2.6–3.9, for gestational and pregestational at term, respectively). Conclusion Diabetes was associated with increased risk of neonatal respiratory morbidity beyond what can be attributed to prematurity. Neonatal respiratory morbidities were increased with pregestational diabetes compared with gestational diabetes.