The association between diabetes in pregnancy and neonatal outcomes.

Abstract

Background: Gestational diabetes (GDM) is the most common form of diabetes in pregnancy. Pre-existing type 1 diabetes (T1D) and type 2 diabetes (T2D) are less common in pregnancy, but still confer great risk to the neonate. Our primary aim was to compare neonatal outcomes for each type of diabetes with pregnancies uncomplicated by diabetes. Method(s): This was a retrospective cohort study of 51 880 pregnancies using Monash Health data from the Birthing Outcome System (BOS) platform from 2015 to 2020 inclusive. The primary outcome was a composite outcome of severe neonatal morbidity, comprising infants with one or more of: respiratory distress syndrome, perinatal asphyxia, NICU admission, intubation or volume expansion management, and death before discharge. Univariable and multivariable logistic regression was utilised to generate odds ratios and 95% confidence intervals for neonatal outcomes of diabetic women compared with non-diabetic women. Result(s): For the primary outcome of severe neonatal morbidity, infants of T1D mothers had almost five times the odds when compared to infants of non-diabetic mothers (aOR 4.7 95% CI 2.8-8.1). T2D conferred the next greatest odds of severe neonatal morbidity (aOR 1.6 95% CI 1.0-2.6), and the odds for GDM were not significantly increased (aOR 1.0 95% CI 0.9-1.1). T1D had increased odds for more outcomes than any other type of diabetes in pregnancy. Conclusion(s): Although T1D places the newborn at greatest risk, both T2D and GDM pregnancies are increasing in society, so all forms of diabetes should receive dedicated counselling and antenatal care.