160 - Effects of Maternal Diabetes on Respiratory Outcomes of Moderately Preterm Infants at UH Rainbow Babies and Children's Hospital

Publication Number: 160.5071

Nadine-Stella Achenjang, UH Rainbow Babies & Children's Hospital, Lakewood, OH, United States; Hilal Yildiz Atar, Oklahoma University Health Sciences Center, Oklahoma city, OK, United States; Samantha Kauffman, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Christopher Nau, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Rita M.. Ryan, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States

Background: It is well established that infants of diabetic mothers (IDMs) are at higher risk for developing respiratory distress syndrome (RDS) due to inhibitory effects on surfactant synthesis and maturation. Since the 1970’s, management of diabetes during pregnancy has significantly improved. We examined the effect of maternal diabetes mellitus (DM) on neonatal respiratory outcomes in the current era.

Objective: To compare respiratory outcomes of infants born between 29 0/7-32 6/7 weeks to mothers with DM and without DM.

Design/Methods: We retrospectively collected data on infants born in 2019-2022 at 29 0/7 to 32 6/7 weeks gestational age (GA) admitted to Rainbow Babies and Children’s NICU (n=387). Maternal, pregnancy, and neonatal data, with a focus on maternal DM and neonatal respiratory outcomes were collected and analyzed. GA range was chosen based on prior pilot data collection to minimize the confounding effects of GA on development of RDS. We hypothesized that infants of diabetic mothers would have poorer respiratory outcomes compared with infants of nondiabetic mothers.

Results: All analyses were constructed using STATA 15.1. Among the 387 infants, 15.8% of pregnancies were complicated by DM. Mean GA was 31.1 (±1.1) weeks. There was a difference in birthweight (p 0.004, ANOVA) with T1DM infants having higher birthweight compared to non-IDMs in post-hoc analysis (p 0.012, Sidak). At least one dose of betamethasone was given to 87% of mothers prior to delivery. There was an overall high cesarean rate; those with pregestational DM (combined T1DM & T2DM) had a significantly increased rate (84.6%) compared to those without DM (62.2%) (p 0.032, Fisher’s). For the analysis, infants were grouped by maternal DM status (Table 1). Using the Vermont Oxford Network (VON) RDS definition, 67.5% infants had RDS, but there was no difference by DM group (Table 2). There was a trend in surfactant use with IDM combined (47%) vs non-IDM (34%) (p < 0.1, Mann-Whitney); and IDM had higher days on positive pressure (p < 0.1, Mann-Whitney). Peak oxygen need during first 4-24 hours of age and time to wean to 21% FiO2 was significantly increased in IDMs (p 0.03, and p < 0.05, Mann-Whitney).

Conclusion(s): While the rates of RDS were not different, the respiratory needs of IDMs compared to non-IDMs were increased. Despite improvements in diabetic management, IDMs remain at increased risk for prolonged respiratory support with positive pressure. Further work is needed to understand the complex effects of diabetes exposure on respiratory morbidity in the moderately preterm infant.

CONSORT Diagram
CONSORT Diagram.pdf

Table 1: Cohort Demographics
Table 1.pdf

Table 2: Respiratory Outcomes
Table 2.pdf