title: [Insulin treatment of gestational diabetes and respiratory outcome in late-preterm and term babies].
abstract: 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 firmly established. To address this gap in understanding, we asked whether DM status and its treatment during pregnancy influence risk of neonatal respiratory distress. We conducted retrospective analysis of a large cohort to determine the relationship between maternal DM status (non-DM, insulin-treated DM [DTI], and non-insulin-treated DM [DTR]) and respiratory distress in term and near-term singletons, born at Robert-Debré Hospital over a 7-year period. Of 18,095 singletons delivered at 34 weeks of gestation or later, 412 (2.3%) were admitted to the NICU for respiratory distress within the first hours of life. The incidence of NICU admissions due to respiratory distress was 2.2% in the non-DM group, 2.1% in the DTR group, and 5.7% in the DTI group. Insulin treatment of DM, together with several other perinatal factors, was associated with an increased risk for severe respiratory distress. In a multivariate model, we found that DTI, but not DTR, was a risk factor independent of gestational age and cesarean section, with an IRR of 1.44 (95% CI, 1.00-2.08). The data indicate that newborns of mothers with DM treated with diet are not at risk for severe respiratory distress. Conversely, newborns of mothers with DM treated with insulin are associated with elevated risk for severe respiratory disease and should therefore be closely monitored.
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, 75019 Paris, France; Neonatal Intensive Care Unit, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Becquet
authors.affiliation: Neonatal Intensive Care Unit, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: El Khabbaz
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, 75019 Paris, France; Inserm U1123, CIC-EC 1426, Unit of Clinical Epidemiology, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Alberti
authors.affiliation: Inserm U1123, CIC-EC 1426, Unit of Clinical Epidemiology, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Mohamed
authors.affiliation: Département d'information médicale, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Blachier
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, 75019 Paris, France; Neonatal Intensive Care Unit, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Biran
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, 75019 Paris, France; Service de gynécologie-obstétrique, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Sibony
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, 75019 Paris, France; Neonatal Intensive Care Unit, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France. Electronic address: olivier.baud@rdb.aphp.fr.
authors.forename: O
authors.initials: O
authors.lastname: Baud
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007231:Infant, Newborn; D007234:Infant, Premature; D007328:Insulin / Q000009:adverse effects*; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D047929:Term Birth
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin