title: Insulin treatment of maternal diabetes mellitus and respiratory outcome in late-preterm and term singletons.
abstract: OBJECTIVE
  While the incidence of diabetes mellitus (DM) during pregnancy has been steadily increasing in recent years, the link between gestational DM and respiratory outcome in neonates has not been definitely established. We asked the question whether DM status and its treatment during pregnancy could influence the risk of neonatal respiratory distress.
  
  
  METHODS
  We studied in a large retrospective cohort the relationship between maternal DM status (non-DM, insulin-treated DM (IT-DM) and non-insulin-treated DM (NIT-DM)), and respiratory distress in term and near-term inborn singletons.
  
  
  RESULTS
  Among 18,095 singletons delivered at 34 weeks of gestation or later, 412 (2.3%) were admitted to the neonatal intensive care unit (NICU) for respiratory distress within the first hours of life. The incidence of NICU admission due to respiratory distress groups was 2.2%, 5.7% and 2.1% in the non-DM, IT-DM and NIT-DM groups, respectively. Insulin treatment of DM, together with several other perinatal factors, was associated with a significant increased risk for respiratory distress. Several markers of the severity of respiratory illness, including durations of mechanical ventilation and supplemental oxygen, and hypertrophic cardiomyopathy were also found increased following IT-DM as compared with NIT-DM. In a multivariate model, we found that IT-DM, but not NIT-DM, was significantly associated with respiratory distress independent of gestational age and caesarean section, with an incidence rate ratio of 1.44 (1.00-2.08).
  
  
  CONCLUSIONS
  This study shows that the treatment of maternal DM with insulin during pregnancy is an independent risk factor for respiratory distress in term and near-term newborns.
authors.affiliation: Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France.
authors.forename: Odile
authors.initials: O
authors.lastname: Becquet
authors.affiliation: Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France.
authors.forename: Fares
authors.initials: F
authors.lastname: El Khabbaz
authors.affiliation: PremUP Foundation, Paris, France Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1123, ECEVE, Paris, France Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France INSERM, U1123 and CIC-EC 1426, Paris, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Alberti
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1123, ECEVE, Paris, France Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France INSERM, U1123 and CIC-EC 1426, Paris, France.
authors.forename: Damir
authors.initials: D
authors.lastname: Mohamed
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Département d'information médicale, Paris, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Blachier
authors.affiliation: Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Biran
authors.affiliation: Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sibony
authors.affiliation: Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Baud
mesh_terms: D000328:Adult; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D007231:Infant, Newborn; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000188:drug therapy*; D047928:Premature Birth; D011297:Prenatal Exposure Delayed Effects / Q000097:blood / Q000517:prevention & control*; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood / Q000139:chemically induced* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D047929:Term Birth
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: NEONATOLOGY