Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

The association of pregestational and gestational diabetes with severe neonatal morbidity and mortality

Journal of Perinatology volume 40, pages 232–239 (2020)Cite this article

Subjects

Abstract

Objective

To estimate the association between maternal diabetes and severe neonatal morbidity.

Study design

Retrospective cohort study of nonanomalous neonates born 240−416 weeks’ gestation from two large multisite U.S. cohorts, Cesarean Registry and Consortium on Safe Labor. The exposure was pregestational versus gestational versus no diabetes. The composite neonatal outcome included respiratory distress syndrome, mechanical ventilation, necrotizing enterocolitis, grade 3-4 intraventricular hemorrhage, and death. Multivariable logistic regression estimated the association between diabetes and neonatal morbidity.

Result

Of 196,006 eligible neonates, 2993 (1.5%) were born to mothers with pregestational diabetes and 10,549 (5.4%) with gestational diabetes. Pregestational diabetes was associated with higher odds of neonatal morbidity versus gestational diabetes (aOR 2.27, 95% CI 1.95−2.64), as well as no diabetes (aOR 1.96, 95% CI 1.63−2.35). Gestational diabetes was associated with higher odds of neonatal morbidity versus no diabetes (aOR 1.16, 95% CI 1.04−1.30).

Conclusion

Pregestational and gestational diabetes are risk factors for severe neonatal morbidity.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Lawrence JM, Chen W, Contreras RSDA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women. Diabetes Care. 2008;31:899–904.

    Article  Google Scholar 

  2. DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, pregnancy risk assessment monitoring system (PRAMS), 2007–2010. Prev Chronic Dis. 2014;11:1–9.

    Article  Google Scholar 

  3. Mitanchez D, Yzydorczyk C, Siddeek B, Boubred F, Benahmed M, Simeoni U. The offspring of the diabetic mother—short- and long-term implications. Best Pr Res Clin Obstet Gynaecol. 2015;29:256–69.

    Article  CAS  Google Scholar 

  4. Weintrob N, Karp M, Hod M. Short- and long-range complications in offspring of diabetic mothers. J Diabetes Complications. 1996;10:294–301.

    Article  CAS  Google Scholar 

  5. Clausen TD, Mathiesen ER, Hansen T, Pedersen O, Jensen DM, Lauenborg J, et al. Overweight and the metabolic syndrome in adult offspring of women with diet-treated gestational diabetes mellitus or type 1 Diabetes. J Clin Endocrinol Metab. 2009;94:2464–70.

    Article  CAS  Google Scholar 

  6. Dabelea D, Hanson RL, Lindsay RS, Pettitt DJ, Imperatore G, Gabir MM, et al. Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships. Diabetes. 2000;49:2208–11.

    Article  CAS  Google Scholar 

  7. American College of Obstetricians and Gynecologists. Pregestational diabetes mellitus. ACOG Practice Bulletin No. 201. Obstet Gynecol. 2018;132:e228–48.

    Article  Google Scholar 

  8. American College of Obstetricians and Gynecologists. Gestational diabetes mellitus. Practice Bulletin No. 180. Obs Gynecol. 2017;130:e17–31.

    Article  Google Scholar 

  9. Metzger BE. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.

    Article  Google Scholar 

  10. Werner EF, Romano ME, Rouse DJ, Sandoval G, Gyamfi-Bannerman C, Blackwell SC, et al. Association of gestational diabetes mellitus with neonatal respiratory morbidity. Obstet Gynecol. 2019;133:349–53.

    Article  Google Scholar 

  11. Tennant PWG, Glinianaia SV, Bilous RW, Rankin J, Bell R. Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study. Diabetologia. 2014;57:285–94.

    Article  CAS  Google Scholar 

  12. Zhang J, Troendle J, Reddy UM, Laughon SK, Branch DW, Burkman R, et al. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol. 2010;203:326.e1–326.e10.

    Article  Google Scholar 

  13. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351:2581–9.

    Article  CAS  Google Scholar 

  14. Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics. 2010;125:e214–24.

    Article  Google Scholar 

  15. Kawakita T, Bowers K, Hazrati S, Zhang C, Grewal J, Chen Z, et al. Increased neonatal respiratory morbidity associated with gestational and pregestational diabetes: a retrospective study. Am J Perinatol. 2017;34:1160–8.

    Article  CAS  Google Scholar 

  16. Gluck L, Kulovich MV. Lecithin-sphingomyelin ratios in amniotic fluid in normal and abnormal pregnancy. Am J Obstet Gynecol. 1973;115:539–46.

    Article  CAS  Google Scholar 

  17. Piper JM, Xenakis EMJ, Langer O. Delayed appearance of pulmonary maturation markers is associated with poor glucose control in diabetic pregnancies. J Matern Fetal Med. 1998;7:148–53.

    CAS  PubMed  Google Scholar 

  18. Piper JM, Langer O. Does maternal diabetes delay fetal pulmonary maturity? Am J Obstet Gynecol. 1993;168:783–6.

    Article  CAS  Google Scholar 

  19. Jacobson JD, Cousins L. A population-based study of maternal and perinatal outcome in patients with gestational diabetes. Am J Obstet Gynecol. 1989;161:981–6.

    Article  CAS  Google Scholar 

  20. Bental Y, Reichman B, Shiff Y, Weisbrod M, Boyko V, Lerner-Geva L, et al. Impact of maternal diabetes mellitus on mortality and morbidity of preterm infants (24–33 weeks’ gestation). Pediatrics. 2011;128:e848–55.

    Article  Google Scholar 

  21. Grimes DA, Schulz KF. False alarms and pseudo-epidemics: the limitations of observational epidemiology. Obstet Gynecol. 2012;120:920–7.

    Article  Google Scholar 

  22. Billionnet C, Mitanchez D, Weill A, Nizard J, Alla F, Hartemann A, et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia. 2017;60:636–44.

    Article  CAS  Google Scholar 

  23. Stacey T, Tennant P, McCowan L, Mitchell E, Budd J, Li M, et al. Gestational diabetes and the risk of late stillbirth: a case–control study from England, UK. BJOG Int J Obstet Gynaecol. 2019;1471–0528:15659.

    Google Scholar 

  24. Persson M, Shah PS, Rusconi F, Reichman B, Modi N, Kusuda S, et al. Association of maternal diabetes with neonatal outcomes of very preterm and very low-birth-weight infants. JAMA Pediatr. 2018;172:867.

    Article  Google Scholar 

  25. 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;173:371–8.

    Article  Google Scholar 

  26. Barta E, Drugan A. Glucose transport from mother to fetus—a theoretical study. J Theor Biol. 2010;263:295–302.

    Article  CAS  Google Scholar 

  27. Hill DE. Insulin and fetal growth. Prog Clin Biol Res. 1976;10:127–39.

    CAS  PubMed  Google Scholar 

  28. Soler NG. Hyperinsulinism and respiratory distress in infants of diabetics. Lancet (Lond, Engl). 1978;1:1054.

    Article  CAS  Google Scholar 

  29. Middleton P, Crowther CA, Simmonds L. Different intensities of glycaemic control for pregnant women with pre-existing diabetes. Cochrane Database Syst Rev. 2016;5:CD008540.

  30. Krohe S, Arikan Y, Bezold C, Byrne E, Rowley WR. Diabetes 2030: insights from yesterday, today, and future trends. Popul Health Manag. 2016;20:6–12.

    PubMed  Google Scholar 

Download references

Acknowledgements

Institutions involved in the Consortium include, in alphabetical order: Baystate Medical Center, Springfield, MA; Cedars-Sinai Medical Center Burnes Allen Research Center, Los Angeles, CA; Christiana Care Health System, Newark, DE; Georgetown University Hospital, MedStar Health, Washington, DC; Indiana University Clarian Health, Indianapolis, IN; Intermountain Healthcare and the University of Utah, Salt Lake City, Ut; Maimonides Medical Center, Brooklyn, NY; MetroHealth Medical Center, Cleveland, OH.; Summa Health System, Akron City Hospital, Akron, OH; The EMMES Corporation, Rockville, MD (Data Coordinating Center); University of Illinois at Chicago, Chicago, IL; University of Miami, Miami, FL; and University of Texas Health Science Center at Houston, Houston, TX.

Funding

This study was supported by the Intramural Research Program of the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The Consortium on Safe Labor was funded by the Intramural Research Program of the NICHD, through Contract No. HHSN267200603425C. Intramural investigators designed the study and data were collected by clinical site investigators. The corresponding author has full access to the data and final responsibility for preparation and submission of the paper for publication.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina, Chapel Hill, NC, USA

    Ashley N. Battarbee, Kartik K. Venkatesh & Kim A. Boggess

  2. Department of Pediatrics, Division of Neonatology, University of North Carolina, Chapel Hill, NC, USA

    Sofia Aliaga

Authors
  1. Ashley N. Battarbee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kartik K. Venkatesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sofia Aliaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kim A. Boggess
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashley N. Battarbee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Presented in poster format at the 39th Annual Meeting of the Society for Maternal-Fetal Medicine, Las Vegas, NV, Feb 11−16, 2019. Poster #495.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Battarbee, A.N., Venkatesh, K.K., Aliaga, S. et al. The association of pregestational and gestational diabetes with severe neonatal morbidity and mortality. J Perinatol 40, 232–239 (2020). https://doi.org/10.1038/s41372-019-0516-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-019-0516-5

This article is cited by

Search

Advanced search

Quick links