RSS-Feed abonnieren
DOI: 10.1055/s-0043-1771501
Impact of Maternal Diabetes Mellitus on Neonatal Outcomes among Infants <32 Weeks of Gestation in China: A Multicenter Cohort Study
Funding This work was supported by the Canadian Institutes of Health Research (CTP87518). The funder did not exert any influence over the conception, design, analysis, or interpretation of the study, or on the writing of the manuscript.![](https://www.thieme-connect.de/media/ajp/2024S01/lookinside/thumbnails/10-1055-s-0043-1771501_22oct1666-1.jpg)
Abstract
Objective Our study aimed to determine the relationship between maternal diabetes mellitus (MDM) and mortality and major morbidities for very preterm infants, as well as the effects of insulin-treated MDM, in the Chinese population.
Study Design This retrospective cohort study included all preterm infants born at 240/7 to 316/7 weeks of gestation and admitted to 57 tertiary neonatal intensive care units participating in the Chinese Neonatal Network in 2019. All infants were followed up until discharging from the hospitals.
Results A total of 9,244 very preterm infants were enrolled, with 1,584 (17.1%) born to mothers with MDM. The rates of mortality or any major morbidity in the MDM and non-MDM groups were 45.9% (727/1,584) and 48.1% (3,682/7,660), respectively. After adjustment, the risk of mortality or any morbidity was not significantly increased in the MDM group (adjusted odds ratio [aOR], 1.07; 95% confidence interval [CI], 0.94–1.22) compared with the non-MDM group. Among MDM mothers with treatment data, 18.0% (256/1,420) were treated with insulin. Insulin-treated MDM was not independently associated with the risk of mortality or any morbidity (aOR, 1.01; 95% CI, 0.76–1.34) among very preterm infants, but it was associated with an elevated risk of severe retinopathy of prematurity (aOR, 2.39; 95% CI, 1.13–5.04).
Conclusion While the MDM diagnostic rate for mothers of very preterm infants was high in China, MDM was not associated with mortality or major morbidities for very preterm infants.
Key Points
-
A total of 17% of very preterm infants in Chinese neonatal intensive care units were born to mothers with MDM.
-
MDM was not related to mortality or major morbidities in very preterm infants.
-
MDM treated by insulin was associated with severe retinopathy of prematurity.
Keywords
very preterm infants - maternal diabetes mellitus - neonatal outcomes - insulin treatment - Chinese Neonatal NetworkAuthors' Contributions
Conception and design: J.Yuan, S.J., R.S., L.Z.; administrative support: L.D., W.Z., Y.C., S.K.L.; provision of study materials or patients: J.Yuan, J.Yang, X.L., J.H.; collection and assembly of data: J.Yuan, X.G., J.Yang, X.L., J.H.; data analysis and interpretation: X.G., J.Yuan, S.J., R.S., L.Z.; manuscript writing: J.Yuan, S.J.; final approval of manuscript: all authors
Data Sharing Statement
The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants according to the CHNN Policies but are available from Y.C., R.S., and L.Z. upon reasonable request.
Ethical Approval
The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was approved by the Ethics Review Board of the Children's Hospital of Fudan University (2018-296). Waiver of consent was granted at all sites.
* Co-first authors
+A complete list of group members appears in the Acknowledgments.
Publikationsverlauf
Eingereicht: 31. Oktober 2022
Angenommen: 26. Juni 2023
Artikel online veröffentlicht:
14. August 2023
© 2023. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 McCance DR. Pregnancy and diabetes. Best Pract Res Clin Endocrinol Metab 2011; 25 (06) 945-958
- 2 Kong L, Nilsson IAK, Gissler M, Lavebratt C. Associations of maternal diabetes and body mass index with offspring birth weight and prematurity. JAMA Pediatr 2019; 173 (04) 371-378
- 3 Metzger BE, Lowe LP, Dyer AR. et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358 (19) 1991-2002
- 4 Mackin ST, Nelson SM, Kerssens JJ. et al; SDRN Epidemiology Group. Diabetes and pregnancy: national trends over a 15 year period. Diabetologia 2018; 61 (05) 1081-1088
- 5 López-de-Andrés A, Perez-Farinos N, Hernández-Barrera V. et al. A population-based study of diabetes during pregnancy in Spain (2009-2015): trends in incidence, obstetric interventions, and pregnancy outcomes. J Clin Med 2020; 9 (02) 582
- 6 Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: a large, population-based study. Diabetes Care 2009; 32 (11) 2005-2009
- 7 Azad MB, Moyce BL, Guillemette L. et al. Diabetes in pregnancy and lung health in offspring: developmental origins of respiratory disease. Paediatr Respir Rev 2017; 21: 19-26
- 8 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314 (10) 1039-1051
- 9 Thanh NX, Toye J, Savu A, Kumar M, Kaul P. Health service use and costs associated with low birth weight–a population level analysis. J Pediatr 2015; 167 (03) 551-6.e1 , 3
- 10 Persson M, Shah PS, Rusconi F. et al; International Network for Evaluating Outcomes of Neonates. Association of maternal diabetes with neonatal outcomes of very preterm and very low-birth-weight infants: an international cohort study. JAMA Pediatr 2018; 172 (09) 867-875
- 11 Rehan VK, Moddemann D, Casiro OG. Outcome of very-low-birth-weight (< 1,500 grams) infants born to mothers with diabetes. Clin Pediatr (Phila) 2002; 41 (07) 481-491
- 12 Boghossian NS, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Outcomes of extremely preterm infants born to insulin-dependent diabetic mothers. Pediatrics 2016; 137 (06) e20153424
- 13 Wei Y, Xu Q, Yang H. et al. Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: a population-based cohort study in China. PLoS Med 2019; 16 (10) e1002926
- 14 Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Ramezani Tehrani F. The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis. Diabetol Metab Syndr 2019; 11: 11
- 15 Cao Y, Jiang S, Sun J. et al; Chinese Neonatal Network. Assessment of neonatal intensive care unit practices, morbidity, and mortality among very preterm infants in China. JAMA Netw Open 2021; 4 (08) e2118904
- 16 Hei M, Li X, Shi Y. et al; Chinese Neonatal Network (CHNN)*. Chinese Neonatal Network: a national protocol for collaborative research and quality improvement in neonatal care. BMJ Open 2022; 12 (05) e051175
- 17 Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association, Group of Pregnancy with Diabetes Mellitus, Chinese Society of Perinatal Medicine, Chinese Medical Association, Obstetrics Subgroup Chinese Society of Obstetrics and Gynecology Chinese Medical Association, Group of Pregnancy with Diabetes Mellitus Chinese Society of Perinatal Medicine Chinese Medical Association. [Diagnosis and therapy guideline of pregnancy with diabetes mellitus]. Zhonghua Fu Chan Ke Za Zhi 2014; 49 (08) 561-569
- 18 Stoll BJ, Hansen N, Fanaroff AA. et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110 (2 Pt 1): 285-291
- 19 Bell MJ, Ternberg JL, Feigin RD. et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
- 20 International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
- 21 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
- 22 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
- 23 Ballard JL, Novak KK, Driver M. A simplified score for assessment of fetal maturation of newly born infants. J Pediatr 1979; 95 (5 Pt 1): 769-774
- 24 Zhu L, Zhang R, Zhang S. et al; Chinese Neonatal Network. [Chinese neonatal birth weight curve for different gestational age]. Zhonghua Er Ke Za Zhi 2015; 53 (02) 97-103
- 25 Grandi C, Tapia JL, Cardoso VC. Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study. J Pediatr (Rio J) 2015; 91 (03) 234-241
- 26 Rani PR, Begum J. Screening and diagnosis of gestational diabetes mellitus, where do we stand. J Clin Diagn Res 2016; 10 (04) QE01-QE04
- 27 ACOG Practice Bulletin No. ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol 2018; 131 (02) e49-e64
- 28 Coustan DR, Dyer AR, Metzger BE. One-step or 2-step testing for gestational diabetes: which is better?. Am J Obstet Gynecol 2021; 225 (06) 634-644
- 29 Liu M, Liu SW, Wang LJ. et al. Burden of diabetes, hyperglycaemia in China from to 2016: findings from the 1990 to 2016, global burden of disease study. Diabetes Metab 2019; 45 (03) 286-293
- 30 GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390 (10100): 1345-1422
- 31 Billionnet C, Mitanchez D, Weill A. et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 2017; 60 (04) 636-644
- 32 Li L, Zhang B, Ding Y. Practice and effect evaluation of gestational diabetes mellitus specialist practice model. Chung Hua Hu Li Tsa Chih 2017; 52 (05) 535-539
- 33 Zhang Y, Du M, Wang M. et al. The relationship between fetal genders and maternal-fetal pregnancy outcomes in gestational diabetes mellitus. Journal of Practical Obstetrics and Gynecology. 2019; 35 (05) 385-389
- 34 Liu X. The effect of nutritional therapy of low-glycemic load food exchange method on blood glucose, insulin usage, weight gain and pregnancy outcome in patients with gestational diabetes. Diabetes New World. 2020; 12: 57-60
- 35 Bental Y, Reichman B, Shiff Y. et al; Collaboration With the Israel Neonatal Network. Impact of maternal diabetes mellitus on mortality and morbidity of preterm infants (24-33 weeks' gestation). Pediatrics 2011; 128 (04) e848-e855
- 36 Jarde A, Feng YY, Viaje KA, Shah PS, McDonald SD. Vaginal birth vs caesarean section for extremely preterm vertex infants: a systematic review and meta-analyses. Arch Gynecol Obstet 2020; 301 (02) 447-458
- 37 Travers CP, Carlo WA, McDonald SA. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Mortality and pulmonary outcomes of extremely preterm infants exposed to antenatal corticosteroids. Am J Obstet Gynecol 2018; 218 (01) 130.e1-130.e13
- 38 Kong X, Xu F, Wu R. et al. Neonatal mortality and morbidity among infants between 24 to 31 complete weeks: a multicenter survey in China from 2013 to 2014. BMC Pediatr 2016; 16 (01) 174
- 39 Scifres CM. Short- and long-term outcomes associated with large for gestational age birth weight. Obstet Gynecol Clin North Am 2021; 48 (02) 325-337
- 40 Horvath K, Koch K, Jeitler K. et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 340: c1395
- 41 Alwan N, Tuffnell DJ, West J. Treatments for gestational diabetes. Cochrane Database Syst Rev 2009; 2009 (03) CD003395
- 42 Tunay ZÖ, Özdemir Ö, Acar DE, Öztuna D, Uraş N. Maternal diabetes as an independent risk factor for retinopathy of prematurity in infants with birth weight of 1500. g or more. Am J Ophthalmol 2016; 168: 201-206
- 43 Opara CN, Akintorin M, Byrd A, Cirignani N, Akintorin S, Soyemi K. Maternal diabetes mellitus as an independent risk factor for clinically significant retinopathy of prematurity severity in neonates less than 1500g. PLoS One 2020; 15 (08) e0236639
- 44 Wang Y, Zhou Y, Xiao L, Zheng S, Yan N, Chen D. E2f1 mediates high glucose-induced neuronal death in cultured mouse retinal explants. Cell Cycle 2017; 16 (19) 1824-1834