#Grand Rounds

Does GDM Independently Increase Risk for Neonatal Respiratory Morbidity?

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.