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Özkan S, Dereli ML, Kurt D, Kurt A, Sucu S, Fıratlıgil FB, İşleyen F, Çelen Ş, Üstün YE. The use of late preterm antenatal corticosteroids in women with gestational diabetes : a puzzle worth solving. BMC Pregnancy Childbirth 2024; 24:286. [PMID: 38637735 PMCID: PMC11027230 DOI: 10.1186/s12884-024-06510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND To investigate the association between late preterm antenatal corticosteroid treatment and outcome in late preterm neonates born to mothers with gestational diabetes mellitus, METHODS: All patients with gestational diabetes mellitus who had a late preterm delivery at Etlik Lady Zübeyde Hospital between 2017 and 2021 were included. Women who met the inclusion criteria and were not given antenatal corticosteroid treatment during current pregnancy before 34 0/7 weeks of gestation were divided into two groups according to whether or not they received late preterm antenatal corticosteroid treatment. The two groups were compared in terms of adverse neonatal complications. The main outcomes were composite respiratory outcome and composite neonatal outcome. Logistic regression analysis was used to determine additional potential predictors of neonatal outcome. RESULTS This retrospective cohort study included a total of 400 participants with gestational diabetes mellitus who had a late preterm delivery within the study period. Of these women, 196 (49%) received late preterm antenatal corticosteroid treatment. Main outcomes showed no difference. Decreasing gestational age at birth was identified as an independent risk factor predicting both composite respiratory outcome and composite neonatal outcome in multivariate logistic regression analysis. CONCLUSIONS Antenatal corticosteroid treatment at or after 34 0/7 weeks of gestation in women with gestational diabetes mellitus who had a late preterm delivery was not associated with improvement in adverse neonatal outcomes. Decreasing gestational age at birth was the only independent risk factor predicting composite neonatal and composite respiratory outcomes.
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Affiliation(s)
- Sadullah Özkan
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey.
| | - Murat Levent Dereli
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Dilara Kurt
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Ahmet Kurt
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Sadun Sucu
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Fahri Burçin Fıratlıgil
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Fatih İşleyen
- Department of Neonatology, Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Şevki Çelen
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
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Khanuja K, Jayakumaran J, Al-Kouatly HB, McLaren RA. Antenatal steroids and neonatal outcomes in late preterm births with pregestational diabetes. Int J Gynaecol Obstet 2024. [PMID: 38340014 DOI: 10.1002/ijgo.15413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To evaluate if antenatal steroid use was associated with a lower rate of respiratory complications in neonates born late preterm to patients with pregestational diabetes mellitus (PGDM). METHODS This was a retrospective cohort study of live, singleton, non-anomalous, late preterm births complicated by PGDM using data from the Centers for Disease Control and National Vital Statistics System from 2017 to 2021. The primary (assisted ventilation use >6 h) and secondary neonatal outcomes (immediate assisted ventilation, Apgar score, neonatal intensive care unit [NICU] admission, and surfactant use) were compared between births that received steroids and those that did not. Multivariable analyses were performed to adjust for differences in demographic and clinical characteristics. RESULTS There were 24 323 late preterm births with PGDM, of which 4613 received antenatal steroids and 19 710 did not receive steroids. After adjusting for the differences among the two groups, the need for assisted neonatal ventilation for more than 6 h (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.53-1.86), immediate assisted neonatal ventilation (aOR 1.67, 95% CI 1.55-1.80), NICU admission (aOR 1.95, 95% CI 1.81-2.10), and surfactant use (aOR 1.68, 95% CI 1.40-2.02) were higher in the births that received steroids compared with those that did not. These findings did not differ when examining outcomes at each gestational week of delivery between 34 weeks 0 days and 36 weeks 6 days. CONCLUSIONS Antenatal steroid use in late preterm births complicated with PGDM was associated with worse immediate respiratory neonatal outcomes. Our findings support current recommendations against the use of steroids in the late preterm period in pregnancies with PGDM.
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Affiliation(s)
- Kavisha Khanuja
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jenani Jayakumaran
- Virtua Maternal Fetal Medicine, Virtua Medical Group, Vorhees, New Jersey, USA
| | - Huda B Al-Kouatly
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rodney A McLaren
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Li X, Zhang J, Hao Q, Du Y, Cheng X. The effect of time interval between antenatal corticosteroid administration and delivery on outcomes in late preterm neonates born to mothers with diabetes: a retrospective cohort study. Front Pediatr 2023; 11:1239977. [PMID: 37691770 PMCID: PMC10485614 DOI: 10.3389/fped.2023.1239977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives The study aims to investigate whether the time interval between administering antenatal corticosteroids (ACS) and delivery influences the neonatal outcomes in late preterm (LPT) neonates (34 + 0 to 36 + 6 weeks) born to mothers with diabetes. Study design This retrospective cohort study included women with any type of diabetes who gave birth between 34 + 0 weeks and 36 + 6 weeks of gestation. Based on the time interval between the first dose of corticosteroid and delivery, the cases were stratified into the following groups: <2, 2-7, and >7 days. Women unexposed to ACS served as the control group. The primary outcomes included the incidence of neonatal hypoglycemia and respiratory distress syndrome/transient tachypnea of the newborn. Multivariate logistic regression was used to assess the relationship between the time interval and neonatal outcomes and adjust for potential confounders. Results The study enrolled a total of 636 parturients. Among them, 247 (38.8%) delivered within 2 days after ACS administration, 169 (26.6%) within 2-7 days, and 126 (19.8%) at >7 days. Baseline characteristics such as type of diabetes, methods of glycemic control, preterm premature rupture of membrane, placenta previa, cesarean delivery, indication for delivery, percentage of large for gestational age, birth weight, and HbA1c in the second or third trimester were significantly different among the four groups. The multivariate analysis showed no statistically significant difference in the incidence of primary or secondary neonatal outcomes between the case and control groups. Conclusions ACS treatment was not associated with neonatal hypoglycemia and respiratory outcomes in LPT neonates born to diabetic mothers, regardless of the time interval to delivery.
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Affiliation(s)
| | | | | | | | - Xiuyong Cheng
- Department of Neonatology, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
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Acmaz G, Ozdemir F, Acmaz B, Madendağ Y, Madendag IÇ, Muderris II. Evaluation of fetal diaphragm excursion and thickness in term pregnancies complicated with pre-gestational and gestational diabetes mellitus. Reprod Health 2022; 19:87. [PMID: 35366925 PMCID: PMC8977043 DOI: 10.1186/s12978-022-01391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Both pre-gestational (PGDM) and gestational diabetes mellitus (GDM) make pregnancy complicated. Moreover in the literature GDM and PGDM have been held responsible for respiratory morbidity in newborns. Diaphragm ultrasound (DUS) is a valuable and noninvasive method that provides an opportunity to examine the diaphragmatic morphology and function. This study examined the quality of fetal diaphragmatic contractions in pregnant women complicated with GDM and PGDM. Methods A total of 105 volunteers who were separated into three groups; (1) A GDM group (n = 35), (2) a PGDM group (n = 35), and (3) a healthy non-diabetic control group (n = 35). All volunteers with the cephalic presentation and only male fetuses were examined in the 37th week of gestation. This cross sectional and case controlled study was performed at the perinatology clinic of the Erciyes University School of Medicine between 15.01.2020 and 01.08.2021. The thickness of fetal diaphragm (DT), diaphragmatic excursion (DE), diaphragm thickening fraction (DTF) and costodiaphragmatic angle (CDA) was measured and recorded by ultrasound and examined on the video frame during the inspiration and expiration phases of respiration. Results Especially the PGDM group represented adversely affected diaphragm function parameters. DT inspiration, DT expiration, DE, CDA inspiration and DTF values were significantly different between PGDM and the control group. Neonatal intensive care unit (NICU) admission was high among babies who were born to pregnancies complicated with PGDM or GDM. Conclusions The quality of fetal diaphragm movements is affected in pregnancies complicated with GDM and PGDM. The prolonged duration of diabetes may have additional adverse effects on diaphragm morphology and its function. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01391-0. The percentage of pre-gestational diabetes mellitus (PGDM) in pregnancy is 13–21% and the remaining part of diabetes is gestational diabetes mellitus (GDM). Both of the complications are related to respiratory problems at birth. Until now, it was known that this situation was due to the lack of surfactant, which has a facilitating effect on the participation of the lungs in respiration. However, in this study, the diaphragm of the babies of patients with PGDM and GDM was examined. The thickness of fetal diaphragm, movements and function were evaluated via using ultrasound. As a result, it was determined that the diaphragm movements were impaired and the babies born from these patients needed more pediatric care. This study will open horizon on new studies examining the functional capacity of the diaphragm in the future. In the future, it may be possible to decide which baby will need intensive care by examining the diaphragm.
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Aboughalia H, Pathak P, Basavalingu D, Chapman T, Revzin MV, Sienas LE, Deutsch GH, Katz DS, Moshiri M. Imaging Review of Obstetric Sequelae of Maternal Diabetes Mellitus. Radiographics 2021; 42:302-319. [PMID: 34855544 DOI: 10.1148/rg.210164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diabetes mellitus, whether preexisting or gestational, poses significant risk to both the mother and the developing fetus. A myriad of potential fetal complications in the setting of diabetic pregnancies include, among others, congenital anomalies, delayed fetal lung maturity, macrosomia, and increased perinatal morbidity and mortality. Congenital anomalies most commonly involve the nervous, cardiovascular, genitourinary, and musculoskeletal systems. Delayed fetal lung maturity, probably secondary to hyperglycemia suppressing surfactant secretion, is a major determinant of perinatal morbidity and mortality. Besides the potential complications encountered during cesarean delivery in macrosomic fetuses, vaginal delivery is also associated with increased risks of shoulder dystocia, clavicular and humeral fractures, and brachial plexus palsy. Maternal complications are related to the increased risk of hypertensive diseases of pregnancy and associated preeclampsia and hemolysis, elevated liver function, and low platelets (HELLP) syndrome, as well as complications encountered at the time of delivery secondary to fetal macrosomia and cesarean delivery. Additional conditions encountered in the setting of maternal diabetes include polyhydramnios, placental thickening, and two-vessel umbilical cord, each of which is associated with adverse fetal and maternal outcomes including fetal growth restriction, preterm labor, placental abruption, and premature rupture of membranes. Imaging plays a vital role in the evaluation of the mother and the fetus and can provide invaluable information that can be used by maternal fetal medicine to manage this patient population effectively. The authors review the pathophysiologic alterations induced by diabetes in pregnancy, discuss the imaging spectrum of diabetic embryopathy, and provide a detailed review of potential associated maternal complications. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hassan Aboughalia
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Priya Pathak
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Deepashri Basavalingu
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Teresa Chapman
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Margarita V Revzin
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Laura E Sienas
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Gail H Deutsch
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Douglas S Katz
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Mariam Moshiri
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
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Perinatal outcome following induction of labor in patients with good glycemic controlled gestational diabetes: does timing matter? Arch Gynecol Obstet 2019; 300:299-303. [DOI: 10.1007/s00404-019-05183-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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McPherson C, Wambach JA. Prevention and Treatment of Respiratory Distress Syndrome in Preterm Neonates. Neonatal Netw 2018; 37:169-177. [PMID: 29789058 DOI: 10.1891/0730-0832.37.3.169] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Respiratory distress syndrome (RDS) impacts a high proportion of preterm neonates, resulting in significant morbidity and mortality. Advances in pharmacotherapy, specifically antenatal corticosteroids and postnatal surfactant therapy, have significantly reduced the incidence and impact of neonatal RDS. Antenatal corticosteroids accelerate fetal lung maturation by increasing the activity of enzymes responsible for surfactant biosynthesis, resulting in improved lung compliance. Maternal antenatal corticosteroid treatment has improved survival of preterm neonates and lowered the incidence of brain injury. After birth, exogenous surfactant administration improves lung compliance and oxygenation, resulting in reductions in the incidence of pneumothorax and of death. Future research will identify the optimal surfactant product, timing of the initial dose, and mode of delivery.
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Krispin E, Hochberg A, Chen R, Wiznitzer A, Hadar E, Borovich A. Neonatal outcome in gestational-diabetic mothers treated with antenatal corticosteroids delivering at the late preterm and term. Arch Gynecol Obstet 2018; 298:689-695. [PMID: 29978413 DOI: 10.1007/s00404-018-4848-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the association between antenatal corticosteroid treatment and neonatal complications in diabetic mothers delivering after 34 weeks of gestation. METHODS A retrospective cohort study of women with singleton pregnancies diagnosed with gestational diabetes who delivered after 34 weeks of gestation in a university-affiliated medical center (2012-2016). Mothers treated with corticosteroids prior to 34 + 0 weeks of gestation were divided according to gestational age at delivery: late-preterm (34 + 0 to 36 + 6) and term (37 + 0 to 41 + 6). Each group was compared to women delivering at the same gestational age who were not treated with corticosteroids. Primary outcome was defined as a neonatal adverse composite outcome. Birth weight was amongst secondary outcomes measured. Logistic regression analysis was utilized to adjust results to potential confounders. RESULTS During the study period, 161 diabetic mothers delivered at late-preterm. Amongst them, 47 (30%) were treated with corticosteroids. 2101 diabetic mothers delivered at term, amongst them 82 (4%) were treated with corticosteroids. Primary outcome did not differ between groups. Multivariate analysis demonstrated that corticosteroid treatment was not associated with neonatal adverse composite outcome when delivery occurred at the late preterm, nor at term (adjusted odds ratio (aOR) = 0.708, 95% CI 0.2-2.3, p = 0.572, and aOR = 1.6, 95% CI 0.2-12.7, p = 0.635, respectively). Birth weight was significantly lower in women treated with corticosteroids (2486 vs. 2675 g, p = 0.02 at late-preterm, and 3160 vs. 3319 g, p < 0.001 at term). CONCLUSION Corticosteroid treatment for diabetic mothers was not associated with neonatal adverse outcomes, but was found associated with a lower birth weight, when delivery occurs after 34 weeks of gestation.
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Affiliation(s)
- Eyal Krispin
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alyssa Hochberg
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rony Chen
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Borovich
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zamstein O, Sheiner E, Wainstock T, Landau D, Walfisch A. Maternal gestational diabetes and long-term respiratory related hospitalizations of the offspring. Diabetes Res Clin Pract 2018; 140:200-207. [PMID: 29626584 DOI: 10.1016/j.diabres.2018.03.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/05/2018] [Accepted: 03/29/2018] [Indexed: 01/17/2023]
Abstract
AIMS To assess the implications of gestational diabetes mellitus (GDM) on long-term respiratory related hospitalizations of the offspring. METHODS A population-based cohort analysis including singleton pregnancies delivered between the years 1991 to 2014 in a tertiary referral hospital was conducted. Incidence of hospitalizations (up to age 18 years) due to various respiratory diseases was compared between offspring of GDM-complicated pregnancies and normoglycemic pregnancies. Kaplan-Meyer curves were used to assess cumulative hospitalization incidence. Cox proportional hazards model was used to control for baseline selected confounders. RESULTS During the study period 216,197 deliveries met the inclusion criteria. Of those, 4.7% (n = 10,184) were complicated by GDM. In most of the investigated respiratory diseases, no significant differences were found between offspring of both groups. Nonetheless, obstructive sleep apnea-related hospitalization rate was higher among the GDM group, an association which proved to be independent of potential confounders with an adjusted hazard ratio of 1.26 (95% CI 1.02-1.55; p = 0.036). CONCLUSION Gestational diabetes mellitus does not appear to be associated with long-term respiratory hospitalizations of the offspring other than obstructive sleep apnea-related hospitalizations.
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Affiliation(s)
- Omri Zamstein
- Goldman School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Is gestational diabetes an independent risk factor of neonatal severe respiratory distress syndrome after 34 weeks of gestation? A prospective study. Arch Gynecol Obstet 2017; 296:1071-1077. [PMID: 28948345 DOI: 10.1007/s00404-017-4505-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate if neonates delivered after 340/7 weeks from mothers diagnosed with gestational diabetes (GD) are exposed to an increased risk of neonatal severe respiratory distress syndrome (SRDS). METHODS Women with singleton pregnancy in labour after 340/7 weeks of gestation or admitted for planned caesarean section and who had been systematically screened for GD were eligible to participate to this prospective cohort study. Diagnosis of SRDS was defined by the association of clinical signs of early neonatal respiratory distress, with consistent radiologic features and requiring mechanical ventilation with a fraction of inspired oxygen (FiO2) >0.25 for a minimum of 24 h and admission to neonatal intensive care unit. RESULTS A total of 444 women were included. GD was diagnosed in 60 patients (13.5%). A neonatal SRDS was diagnosed in 32 cases (7.2%). Compared to others, neonatal SRDS was significantly more often observed in neonates from women diagnosed with GD: 12 (20%) vs. 20 (5.2%), respectively (p < 0.001). Women whose neonates presented neonatal SRDS were significantly more likely to be obese (p = 0.002), to have undergone a caesarean section (p < 0.001) and to have received corticosteroids therapy before 340/7 weeks (p = 0.013). In multivariate analysis, GD was identified as an independent risk factor of neonatal SRDS (aOR 3.6; 95% CI 1.5-8.6; p = 0.005). Other risk factors were maternal obesity (aOR 2.8; 95% CI 1.1-7.1; p = 0.029) and assisted vaginal delivery (aOR 5.5; 95% CI 1.9-15.9; p = 0.002). CONCLUSIONS GD is an independent risk factor of neonatal SRDS after 340/7 weeks.
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Vilchez GA, Dai J, Hoyos LR, Gill N, Bahado-Singh R, Sokol RJ. Labor and neonatal outcomes after term induction of labor in gestational diabetes. J Perinatol 2015; 35:924-9. [PMID: 26313053 DOI: 10.1038/jp.2015.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/11/2015] [Accepted: 07/22/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To identify the optimal gestational age (GA) for induction of labor (IOL) at term among patients with gestational diabetes (GDMA) according to perinatal outcomes. STUDY DESIGN The US Natality Database from 2007 to 2010 was reviewed. Inclusion criteria were singleton delivery, IOL at 37 to 42 weeks and GDMA. Exclusion criteria included congenital anomalies, pre-gestational diabetes, hypertensive disorders, previous cesarean, breech presentation and rupture of membranes. Controls were non-GDMA cases delivered in geographic and temporal proximity. Delivery mode, macrosomia and perinatal complications were analyzed. Logistic regression adjusted for confounders was used to calculate odds ratios by GA using 39 weeks non-GDMA as reference. RESULTS In all, 96,964 cases and 176,079 controls were included. Increased risk for all adverse outcomes among GDMA cases was found. The nadir for intrapartum and neonatal complications was 38 and 40 weeks, respectively, whereas for cesarean and macrosomia was 39 weeks. CONCLUSION The optimal timing for IOL at term in GDMA appears to be 39 to 40 weeks.
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Affiliation(s)
- G A Vilchez
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - J Dai
- C.S Mott Center for Human Growth and Development, Wayne State University, Detroit, MI, USA
| | - L R Hoyos
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - N Gill
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - R Bahado-Singh
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - R J Sokol
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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Dorey M, Boileau A, Pourrat O, Maréchaud R, Pierre F. [Maternal diabetic ketosic decompensation which occurred during corticotherapy for fetal lung maturation. A report of three cases]. J Gynecol Obstet Hum Reprod 2014; 43:633-636. [PMID: 24060547 DOI: 10.1016/j.jgyn.2013.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 07/16/2013] [Accepted: 08/13/2013] [Indexed: 06/02/2023]
Abstract
Three cases of ketosis decompensation occurring immediately in type I diabetic after corticotherapy for lung foetal maturation (LFM) are reported. Few of observations have been published. Increasing doses of insulin is mandatory under close monitoring of blood glucose levels, in particular according to the protocol proposed by Kaushal et al.: infusion of insulin adapted to the results of glucose levels, as a supplementation to the usual doses in each patient. Diabetes does not lead to hesitate prescribing a corticotherapy for LFM, but requires a strict control of needs in insulin to avoid a ketosis decompensation.
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Affiliation(s)
- M Dorey
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France.
| | - A Boileau
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
| | - O Pourrat
- Service de réanimation médicale et médecine interne, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
| | - R Maréchaud
- Service d'endocrinologie et maladies métaboliques, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
| | - F Pierre
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
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McGillick EV, Morrison JL, McMillen IC, Orgeig S. Intrafetal glucose infusion alters glucocorticoid signaling and reduces surfactant protein mRNA expression in the lung of the late-gestation sheep fetus. Am J Physiol Regul Integr Comp Physiol 2014; 307:R538-45. [PMID: 24990855 DOI: 10.1152/ajpregu.00053.2014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Increased circulating fetal glucose and insulin concentrations are potential inhibitors of fetal lung maturation and may contribute to the pathogenesis of respiratory distress syndrome (RDS) in infants of diabetic mothers. In this study, we examined the effect of intrafetal glucose infusion on mRNA expression of glucose transporters, insulin-like growth factor signaling, glucocorticoid regulatory genes, and surfactant proteins in the lung of the late-gestation sheep fetus. The numerical density of the cells responsible for producing surfactant was determined using immunohistochemistry. Glucose infusion for 10 days did not affect mRNA expression of glucose transporters or IGFs but did decrease IGF-1R expression. There was reduced mRNA expression of the glucocorticoid-converting enzyme HSD11B-1 and the glucocorticoid receptor, potentially reducing glucocorticoid responsiveness in the fetal lung. Furthermore, surfactant protein (SFTP) mRNA expression was reduced in the lung following glucose infusion, while the number of SFTP-B-positive cells remained unchanged. These findings suggest the presence of a glucocorticoid-mediated mechanism regulating delayed maturation of the surfactant system in the sheep fetus following glucose infusion and provide evidence for the link between abnormal glycemic control during pregnancy and the increased risk of RDS in infants of uncontrolled diabetic mothers.
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Affiliation(s)
- Erin V McGillick
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia; and Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia; and
| | - I Caroline McMillen
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia; and
| | - Sandra Orgeig
- Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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Abstract
Gestational diabetes mellitus (GDM) from all causes of diabetes is the most common medical complication of pregnancy and is increasing in incidence, particularly as type 2 diabetes continues to increase worldwide. Despite advances in perinatal care, infants of diabetic mothers (IDMs) remain at risk for a multitude of physiologic, metabolic, and congenital complications such as preterm birth, macrosomia, asphyxia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia and hyperviscosity, hypertrophic cardiomyopathy, and congenital anomalies, particularly of the central nervous system. Overt type 1 diabetes around conception produces marked risk of embryopathy (neural tube defects, cardiac defects, caudal regression syndrome), whereas later in gestation, severe and unstable type 1 maternal diabetes carries a higher risk of intrauterine growth restriction, asphyxia, and fetal death. IDMs born to mothers with type 2 diabetes are more commonly obese (macrosomic) with milder conditions of the common problems found in IDMs. IDMs from all causes of GDM also are predisposed to later-life risk of obesity, diabetes, and cardiovascular disease. Care of the IDM neonate needs to focus on ensuring adequate cardiorespiratory adaptation at birth, possible birth injuries, maintenance of normal glucose metabolism, and close observation for polycythemia, hyperbilirubinemia, and feeding intolerance.
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Affiliation(s)
- William W Hay
- Anschutz Medical Campus, F441, Perinatal Research Center, University of Colorado School of Medicine, 13243 East 23rd Avenue, Aurora, CO 80045, USA.
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Abstract
In spite of clinicians apparently appreciating the risks of maternal diabetes to the baby, babies of mothers with diabetes are still at increased risk compared to those of non-diabetic women. The rate of prematurity in infants of diabetic mothers is five times that of the general population. Women with pre-gestational diabetes give birth to larger babies. In a recent study, half were above the 90th centile for weight. The postnatal management of these babies continues to give cause for concern. In a recent UK study, over half of all infants of diabetic mothers were admitted to a neonatal unit. One-third of these were at term. This admission rate is three times the UK average and examination of cases showed that two-thirds of admissions were unnecessary. It is likely that a high maternal blood glucose concentration is the most important factor causing this increased risk. Babies of women with type 1 and type 2 DM have similar complication rates. Tighter preconceptional glycaemic control as well as during the pregnancy is likely to be important in improving outcome for the babies of diabetic mothers.
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Affiliation(s)
- A Michael Weindling
- School of Reproductive and Developmental Medicine, University of Liverpool, and Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK.
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Treviño-Alanís M, Ventura-Juárez J, Hernández-Piñero J, Nevárez-Garza A, Quintanar-Stephano A, González-Piña A. Delayed lung maturation of foetus of diabetic mother rats develop with a diminish, but without changes in the proportion of type I and II pneumocytes, and decreased expression of protein D-associated surfactant factor. Anat Histol Embryol 2009; 38:169-76. [PMID: 19245670 DOI: 10.1111/j.1439-0264.2008.00902.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Newborn children of diabetic mothers have an increased morbidity and mortality because of respiratory distress syndrome. We study lung histogenesis during intrauterine development of offspring of diabetic Sprague-Dawley rats at 18, 19 and 21 days of gestation (DG). Pregnant rats were grouped into diabetic (streptozotocin-induced), citrate, and control groups; five female and five male offspring were selected randomly from each group at 18, 19 and 21 DG, and a biopsy of the lung was taken and processed in paraffin for histological examination. The biopsy for the transmission electron microscopy (TEM) analysis was taken at 21 days. A delay in alveolization of the offspring at 18, 19 and 21 days of the diabetic group was observed, which was confirmed at TEM level, and also less quantity of protein D associated to surfactant in diabetic group was detected (P < 0.001). The foetuses of the diabetic group presented a delay in lung histogenesis and in differentiation of the type II pneumocytes cells, but conserved the proportion with a decrease in 50% of pneumocytes, accompanied by a diminish of protein D associated to surfactant factor.
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Affiliation(s)
- M Treviño-Alanís
- Department of Basic Science, Health Science Division, University of Monterrey, Nuevo León, Mexico
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Barondiot C, Morel O, Vieux R, Sery GA, Floriot M, Hascoet JM. Maturation par bêtaméthasone au cours d'une grossesse de femme présentant un diabète compliqué: le mieux est-il l'ennemi du bien? Arch Pediatr 2007; 14:989-92. [PMID: 17459675 DOI: 10.1016/j.arcped.2007.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 03/28/2007] [Indexed: 10/23/2022]
Abstract
Diabetic pregnancy is a precarious situation, both for mother and fetus, because it increases the risk of prematurity and respiratory distress. We report 3 cases of severe acute complications following antenatal betamethasone treatment in mothers presenting with severe diabetes. Corticosteroids are strongly recommended to prevent prematurity complications in newborns. We highlight the high risk profile of theses pregnancies, the effect of this treatment on the mother and the child, and question the real benefit of corticotherapy for these fragile newborns. The metabolic and blood pressure balance is dangerously disturbed in such pregnancies by this treatment. This brings the question of how justified are corticosteroids in such cases?
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Affiliation(s)
- C Barondiot
- Service de néonatalogie-soins intensifs et réanimation néonatals, maternité régionale Nancy-Universités, 10, rue du Docteur-Heydenreich, 54042 Nancy, France
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Affiliation(s)
- M D Berkus
- Magella Medical Associates DBA TPG, San Antonio, Texas, USA
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