Outcome of Very-Low-Birth-Weight (<1,500 Grams) Infants Born to Mothers with Diabetes

Abstract

Premature delivery is common in pregnancies complicated by maternal diabetes. However, the outcome of very-low-birth-weight infants (VLBWI) born to mothers with diabetes is not known. Employing a matched double-cohort design, we investigated the influence of maternal diabetes on the outcome of VLBWI born in Winnipeg from 1988 to 1994. We compared mortality rates and early and late morbidity rates in VLBWI born to mothers with diabetes mellitus (DM) (cases, n=43, 23 with gestational DM and 20 with pregestational DM) and without DM (controls, n=539). Controls were matched for gestational age (GA), sex, and the year of birth. All subjects were enrolled in the Newborn Follow-Up Program. Relative risks and 95% confidence limits were calculated for each variable and Chi2 analysis, Student t-test, and Mann-Whitney test were used as appropriate for analysis. Diabetes mellitus control was assessed by conventional criteria. There were no differences between cases and controls in mode of delivery, birth weight (mean SD, 1,160±25 g vs 1,110±26 g), GA (29±2.8 wk vs 29±2.4 wk), smallness for gestational age (35% vs 30%), head circumference (26.5±1.9 vs 26.2±2.2 cm), length (38.8±2.8 vs 37.5±3.7 cm), Apgar score <4 at 1 min (42% vs 40%) and <7 at 5 min (37% vs 42%). Incidence of hyaline membrane disease (60% vs 71%), bronchopulmonary dysplasia (33% vs 31%), patent ductus arteriosus (30% vs 43%), necrotizing enterocolitis (12% vs 12%), sepsis (23% vs 25%), acute renal failure (9% vs 10%), intraventricular hemorrhage-all grades (74% vs 64%), retinopathy of prematurity-all stages (30% vs 26%), median days on ventilator (4 vs 4 days), and median days on supplemental oxygen (46 vs 42 days) were similar in both groups (p=NS, 95% confidence limits included 1 for all of these variables). There was no significant difference in mortality (21% vs 15%) or the incidence of major congenital anomalies. Weight, head circumference, and length at 6,12, and 18 months were similar in both groups. There were no group differences in developmental quotients, prevalence of neurodevelopmental impairments, respiratory morbidity, or number of hospitalizations up to the last follow-up (18 months). Our data suggest that with contemporary perinatal care there is no significant increase in mortality rates or early and late morbidity rates between VLBWI born to mothers with DM and VLBWI of nondiabetic mothers. It seems that with reasonable diabetic control, prematurity rather than the diabetic state determines the neonatal outcome, and this knowledge can be useful in parental counselling.

References

1. Kuhl C , Hornnes PJ , Anderson C . Aetiology and pathophysiology of gestational diabetes mellitus. Diabetes. 1985; 34:66-70.

2. Sepe SJ , Connell FA , Geiss LS , et al. Gestational diabetes, incidence, maternal characteristics and perinatal outcome. Diabetes. 1985;34(suppl 2):13-16.

3. Mimouni F , Miodovnik M , Siddiqi TA , et al. High spontaneous premature labour rate in insulin-dependent diabetic pregnant woman: an association with poor glycemic control and urogenital infection. Obstet Cynecol. 1988; 72:175-180.

4. Cousins L . Pregnancy complications among diabetic women: review 1965-1985. Obstet Gynecol Surv. 1987; 42:140-149.

5. Greene MF , Hare JW , Krache M , et al. Prematurity among insulin-requiring diabetic gravid women. Am J Obstet Gynecol. 1989;161:106-111.

6. Cordero L , Treuer SH , Landon MB , Gabbe SG . Management of infants of diabetic mothers. Arch Pediatr Adolesc Med. 1998;152:249-254.

7. Zalut T , Reed KL , Shenker L . Incidence of premature labour in diabetic patients. Am J Perinatol. 1985;2:276-278.

8. Hanson V , Persson B , Stangenberg M . Factors influencing neonatal morbidity in diabetic pregnancy. Diabetes Res. 1986;3:71-76.

9. Vohr BR , Garcia-Coll C , Oh W . Language and neurodevelopmental outcome of low birth weight infants at three years. Dev Med Child Neurol. 1974;16:143-149.

10.

10. Yu VYH , Zhao SM , Bajuk B . Results of intensive care for 375 very low birth weight infants. Aust Pediatr 1982;18:188-192.

11.

11. Cohen SE , Sigman M , Parmelee AH , Beckwith L . Perinatal risk and developmental outcome in preterm infants. Semin Perinatol. 1982;6:334-339.

12.

12. Bennett FC , Robinson NM , Sells CJ . Growth and development of infants weighing less than 800 grams at birth. Pediatrics. 1983;71:319-323.

13.

13. Ross G . Mortality and morbidity in very low birth weight infants. Pediatr Ann. 1983;12:32-44.

14.

14. Levi S , Taylor W , Robinson LE , Levy LI . Analysis of morbidity and outcome of infants weighing less than 800 grams at birth. South Med j. 1984;77:975-978.

15.

15. Shennan AT , Milliganj E , Hoskins EM . Perinatal factors associated with death or handicap in very preterm infants. Amf Obstet Gynecol. 1985;151:231-238.

16.

16. Touwen BC . Very low birth weight infants (editorial). Eur J Pediatr 1986; 145:460-460.

17.

17. Haas G , Asprion B , Leidig E , et al. Obstetrical and neonatal risk factors in very low birth weight infants related to their neurological development. Eur J Pediatr 1986;145:341-346.

18.

18. Kitchen WH , Ford GW , Rickards AL , et al. Children of birth weight <1,000 g: changing outcome between ages 2 and 5 years. J Pediatr 1987;110:283-288.

19.

19. Kitchen W , Ford G , Orgill A , et al. Outcome in infants of birth weight 500-999 g: a continuing regional study of 5-year-old survivors. J Pediatr 1987;111:761-766.

20.

20. Shankaran S , Koepke T , Woldt E , et al.Outcome after posthemorrhagic ventriculomegaly in comparison with mild hemorrhage without ventriculomegaly.J Pediatr 1989;114:109-114.

21.

21. Aylward GP , Pfeiffer SI , Wright A , Verhulst SJ . Outcome studies of low birth weight infants published in the last decade: a metanalysis. J Pediatr. 1989;115:515-520.

22.

22. Leonard CH , Clyman RI , Piecuch RE , et al. Effect of medical and social risk factors on outcome of prematurity and very low birth weight. J Pediatr 1990;116:620-626.

23.

23. Hoffman EL , Bennett FC . Birth weight less than 800 grams: changing outcomes and influences of gender and gestational number. Pediatrics. 1990;86:27-34.

24.

24. Long W , Thompson T , Sundell H , et al. Effects of two rescue doses of a synthetic surfactant on mortality in 700-to 1350-gram infants with respiratory distress syndrome. J Pediatr 1991;118:595-605.

25.

25. Usher R , Mc Lean F . Intrauterine growth of live born Caucasian infants at sea level: standards obtained for measurements in seven dimensions of infants born between 25 and 44 weeks of gestation.J Pediatr 1969;74:901-910.

26.

26. Papile LA , Burstein J , Burstein R , Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 grams. J Pediatr 1978;92:529-534.

27.

27. Bancalari E , Gerhardt T . Bronchopulmonary dysplasia. Pediatr Clin North Am. 1986;33:1-23.

28.

28. Weindling AM . Blood pressure monitoring in the newborn. Arch Dis Child. 1989;64:444-447.

29.

29. The committee for the classification of retinopathy of prematurity: an international classification of retinopathy of prematurity. Arch Ophthalmol. 1984;102:1130-1134.

30.

30. American College of Obstetricians and Gynecologists . Management of diabetes mellitus in pregnancy. ACOG Technical bulletin 92, Washington, DC, 1986.

31.

31. Knobloch H , Pasamanick B . Stages of development. In: Knobloch H , Pasamanick B , eds. Gesell and Amatruda's Developmental Diagnosis. New York: Harper & Row Publishers Inc; 1974:25-116.

32.

32. Jocelyn LJ , Casiro OG . Neurodevelopmental outcome of term infants with intraventricular hemorrhage. Am JDis Child. 1992;146:194-197.

33.

33. Breslow, NE , Day NE . Statistical methods in Cancer Research, vol 1. The Analysis of Case-Control Studies. Lyon, France: World Health Organization International Agency for Research on Cancer, 1980.

34.

34. Nesbitt TS , Gilbert WM , Herrchen B . Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol. 1998;179:476-480.

35.

35. Albert TJ , Landon MB , Wheller J , et al. Prenatal detection of fetal anomalies in pregnancies complicated by insulin-dependent diabetes mellitus. Am J Obstet Gynecol. 1996;174:1424-1428.

36.

36. Robert MF , Neff RK , Hubbell JP , et al. Association between maternal diabetes and the respiratory distress syndrome in the newborn. N Engl JMed. 1976;294:357-360.

37.

37. Kjos SL , Walther FJ , Montoro M , et al. Prevalence and etiology of respiratory distress in infants of diabetic mothers: predictive value of fetal lung maturation tests. Am J Obstet Gynecol. 1990; 163:898-903.

38.

38. Hunter DJS , Burrows RF , Mohide PT , Whyte RK Influence of maternal insulin dependent diabetes mellitus on neonatal morbidity. Can Med Assocfj 1993;149:47-52.

39.

39. Mimouni F , Miodovnik M , Whitsett JA , et al. Respiratory distress syndrome in infants of diabetic mothers in the 1980s. No direct adverse effect of maternal diabetes with modern management. Obstet Cynecol. 1987;69: 191-195.

40.

40. Petersen MB , Pedersen SA , Greisen G , et al. Early growth delay in diabetic pregnancy: relation to psychomotor development at age 4. Br Medj. 1988;296:598-600.

41.

41. Goldstein E , Porter B , Galil A . Neurodevelopmental outcome of offsprings of diabetic mothers: Need for further research. Am JDis Child. 1991; 145:602-603.

42.

42. Sells CJ , Robinson NM , Brown Z , Knopp RH . Long term developmental follow-up of infants of diabetic mothers. J Pediatr 1994;125:S9-17.

43.

43. Persson B , Gentz J . Follow-up of children of insulin dependent and gestational diabetic mothers. Neuropsychological outcome. Acta Paediatr Scand. 1984;73:349-358.

44.

44. Hadden DR , Byrne E , Trotter I , et al. Physical and psychological health of children of type I (insulin-dependent) diabetic mothers. Diabetologia. 1984;26:250-254.

45.

45. Churchill JA , Berendes HW , Nemores J . Neuropsychological deficits in children of diabetic mothers. Am J Obstet Cynecol. 1969;105:257-268.

46.

46. Stebbens JA , Baker GL , Kitchell M . Outcome of ages 1, 3 and 5 years of children born to diabetic women. Am J Obstet Gynecol. 1977; 127:408-413.

47.

47. Lindahl E , Michelsson K , Helenious M , Parre M . Neonatal risk factors and later neurodevelopmental disturbances. Dev Med Child Neurol. 1988:571-589.

48.

48. Silva PA , McGee R , Williams S . A seven year follow-up study of the cognitive development of children who experienced common perinatal problems. Aust Pediatrj. 1984;20:23-28.

49.

49. Yu VYH , Orgill AA , Bajuk B , Astbury J . Survival and 2-year outcome of extremely preterm infants. Br J Obstet Gynecol. 1984;91:640-646.

50.

50. Low JA , Galbraith RS , Muir DW , et al. The predictive significance of biologic risk factors for deficits in children of a high risk population. Am J Obstet Cynecol. 1983;145:1059-1068.

51.

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

52.

52. Ornoy A , Wolf A , Ratzon N , et al. Neurodevelopment outcome at early school age of children born to mothers with gestational diabetes. Arch Dis Child Fetal Neonatal Ed 1999;81:F1O-F14.