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#Grand Rounds

Does GDM Independently Increase Risk for Neonatal Respiratory Morbidity?

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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

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ACOG Releases Updated Guidance on Gestational Diabetes
Practical obstetrics info for your women's healthcare practice
GDM and Postpartum Followup – The ‘When and How’ of Screening
Practical obstetrics info for your women's healthcare practice
What Is The ‘One-Step’ GDM Screening Approach?

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