BACKGROUND AND PURPOSE:

• Literature is conflicting as to whether gestational diabetes mellitus (GDM) is independently associated with neonatal respiratory distress syndrome (RDS)
• Werner et al. (Obstetrics & Gynecology, 2019) assessed neonatal respiratory morbidity in pregnancies with and without GDM

METHODS:

• Secondary analysis of a randomized placebo-controlled trial (RCT)
  • ‘Antenatal Late Preterm Delivery Steroids’ (NICHD MFMU network)
  • Singleton pregnancies
  • High risk for late preterm delivery
  • Randomized to receive either betamethasone or placebo
• Current study primary outcome
  • Composite outcome of neonatal respiratory morbidity in the first 72 hours of life
• Secondary outcomes included
  • Neonatal severe respiratory complications | NICU stay ≥3 days | Hyperbilirubinemia

RESULTS:

• 306 (10.8%) of the 2,831 women in parent study had GDM
• Compared to women without GDM, women with GDM were of increased
  • Age
  • Parity
  • Likelihood for hypertensive disorders of pregnancy
• Women in both groups, with and without GDM, were similar with respect to
  • Race
  • Gestational age at
    • Randomization: 35.6 weeks
    • Delivery: 36.1 weeks
  • Primary outcome: No statistical difference was found
    • GDM: 12.1%
    • No GDM: 13.1%
    • adjusted relative risk (RR) 0.84 (95% CI, 0.61–1.17)
    • Results unchanged when mode of delivery included in the model
      • RR 0.81 (95% CI, 0.56–1.18)
    • Severe respiratory complications or prolonged NICU admission also not statistically different between groups
    • Hyperbilirubinemia: More likely in GDM group (P=.04)
      • GDM: 15.0%
      • No GDM 10.3%
      • Adjusted RR 1.39 (95% CI, 1.03–1.88)

CONCLUSION:

• Maternal GDM was not associated with an increased risk of neonatal respiratory morbidity
• The authors conclude that

This suggests that evidence-based interventions known to reduce morbidity (eg, induction at 37 weeks for preeclampsia without severe features and induction at 39 weeks for low-risk women), should be considered in all women regardless of their GDM status.

Learn More – Primary Sources:

Association of Gestational Diabetes Mellitus With Neonatal Respiratory Morbidity

Related ObG Topics:

ACOG Releases Updated Guidance on Gestational Diabetes

GDM and Postpartum Followup – The ‘When and How’ of Screening

What Is The ‘One-Step’ GDM Screening Approach?