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Am J Perinatol
DOI: 10.1055/s-0043-1771501
Original Article

Impact of Maternal Diabetes Mellitus on Neonatal Outcomes among Infants <32 Weeks of Gestation in China: A Multicenter Cohort Study

Jing Yuan   *
1   Department of Neonatology, Qingdao Women and Children's Hospital, Qingdao, Shandong Province, China
,
Xinyue Gu   *
2   NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
,
Jie Yang
3   Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, Guangdong Province, China
,
Xinzhu Lin
4   Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
,
Jingfei Hu
5   Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
,
Siyuan Jiang
2   NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
5   Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
,
Lizhong Du
6   Department of Neonatology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
,
Wenhao Zhou
2   NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
5   Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
,
Yun Cao
2   NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
5   Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
,
Shoo K. Lee
7   Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada
8   Department of Pediatrics, University of Toronto, Toronto, Canada
,
Ruobing Shan
1   Department of Neonatology, Qingdao Women and Children's Hospital, Qingdao, Shandong Province, China
,
Lan Zhang
2   NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
5   Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
,
the Chinese Neonatal Network › Author Affiliations Funding This work was supported by the Canadian Institutes of Health Research (CTP87518). The funder did not exert any influence over the conception, design, analysis, or interpretation of the study, or on the writing of the manuscript.
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Abstract

Objective Our study aimed to determine the relationship between maternal diabetes mellitus (MDM) and mortality and major morbidities for very preterm infants, as well as the effects of insulin-treated MDM, in the Chinese population.

Study Design This retrospective cohort study included all preterm infants born at 240/7 to 316/7 weeks of gestation and admitted to 57 tertiary neonatal intensive care units participating in the Chinese Neonatal Network in 2019. All infants were followed up until discharging from the hospitals.

Results A total of 9,244 very preterm infants were enrolled, with 1,584 (17.1%) born to mothers with MDM. The rates of mortality or any major morbidity in the MDM and non-MDM groups were 45.9% (727/1,584) and 48.1% (3,682/7,660), respectively. After adjustment, the risk of mortality or any morbidity was not significantly increased in the MDM group (adjusted odds ratio [aOR], 1.07; 95% confidence interval [CI], 0.94–1.22) compared with the non-MDM group. Among MDM mothers with treatment data, 18.0% (256/1,420) were treated with insulin. Insulin-treated MDM was not independently associated with the risk of mortality or any morbidity (aOR, 1.01; 95% CI, 0.76–1.34) among very preterm infants, but it was associated with an elevated risk of severe retinopathy of prematurity (aOR, 2.39; 95% CI, 1.13–5.04).

Conclusion While the MDM diagnostic rate for mothers of very preterm infants was high in China, MDM was not associated with mortality or major morbidities for very preterm infants.

Key Points

  • A total of 17% of very preterm infants in Chinese neonatal intensive care units were born to mothers with MDM.

  • MDM was not related to mortality or major morbidities in very preterm infants.

  • MDM treated by insulin was associated with severe retinopathy of prematurity.

Keywords

very preterm infants - maternal diabetes mellitus - neonatal outcomes - insulin treatment - Chinese Neonatal Network

Authors' Contributions

Conception and design: J.Yuan, S.J., R.S., L.Z.; administrative support: L.D., W.Z., Y.C., S.K.L.; provision of study materials or patients: J.Yuan, J.Yang, X.L., J.H.; collection and assembly of data: J.Yuan, X.G., J.Yang, X.L., J.H.; data analysis and interpretation: X.G., J.Yuan, S.J., R.S., L.Z.; manuscript writing: J.Yuan, S.J.; final approval of manuscript: all authors


Data Sharing Statement

The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants according to the CHNN Policies but are available from Y.C., R.S., and L.Z. upon reasonable request.


Ethical Statement

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was approved by the Ethics Review Board of the Children's Hospital of Fudan University (2018-296). Waiver of consent was granted at all sites.


* Co-first authors


+A complete list of group members appears in the Acknowledgments.




Publication History

Received: 31 October 2022

Accepted: 26 June 2023

Article published online:
14 August 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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