Impact on Neonatal Outcomes with Late Preterm and Early Term Delivery in Women with Diabetes

Abstract

Objective Late preterm and early term deliveries are common in pregnancies complicated by diabetes due to higher rates of obstetric complications including increased stillbirth risk. However, early delivery is associated with multiple neonatal adverse outcomes, which may be further increased by maternal diabetes. We examined whether there is an additive effect on adverse neonatal outcomes in the setting of maternal diabetes in the late preterm and early term periods.

Study Design This was a retrospective cohort study of women with a singleton, nonanomalous pregnancy delivering at a single academic medical center in the late preterm (34^0/7–36^6/7 weeks) or early term (37^0/7–38^6/7 weeks) period between 2010 and 2019. Women were categorized by diabetes status: no diabetes, type 1 (T1DM), type 2 (T2DM), or gestational diabetes (GDM). Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for risk of both mild and severe composite neonatal outcome with delivery in the late preterm or early term period using pregnancies without diabetes as the referent.

Results A total of 8,072 pregnancies were included with T1DM, T2DM, and GDM complicating 1.8, 5.6, and 9.9% of pregnancies, respectively. Expected demographic differences were seen among groups including higher rates of non-Hispanic Black race, chronic hypertension, and higher body mass index in women with T2DM. The probability of severe composite adverse neonatal outcome was significantly increased in women with T1DM in the late preterm (aOR: 4.4; CI: 2.4–8.1) and early term (aOR: 1.6; CI: 1.1–2.3) periods, largely driven by the need for mechanical ventilation. The mild composite outcome was increased among all women with diabetes with early term delivery but highest in women with T1DM.

Conclusion Pregnancies complicated by diabetes, particularly T1DM, have higher rates of neonatal adverse outcomes independent of gestational age at delivery, which is an important consideration when late preterm or early term delivery is planned.

Key Points

• Diabetes in pregnancy increases risk of early delivery.

• Adverse neonatal outcomes are higher with diabetes, especially T1DM.

• Adverse neonatal outcomes are independent of gestational age.

Keywords

diabetes in pregnancy - neonatal outcomes - late preterm - early term

• References

• 1 Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract 2014; 103 (02) 176-185
• 2 Billionnet C, Mitanchez D, Weill A. et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 2017; 60 (04) 636-644
• 3 Feig DS, Hwee J, Shah BR, Booth GL, Bierman AS, Lipscombe LL. Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: a large, population-based study in Ontario, Canada, 1996–2010. Diabetes Care 2014; 37 (06) 1590-1596
• 4 National Diabetes Statistics Report, 2020 | CDC. https://www.cdc.gov/diabetes/data/statistics-report/index.html
• 5 Diabetes During Pregnancy | Maternal Infant Health | Reproductive Health | CDC. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/diabetes-during-pregnancy.htm
• 6 Hu FB, Manson JE, Stampfer MJ. et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001; 345 (11) 790-797
• 7 Catalano PM, Sacks DA. Timing of indicated late preterm and early-term birth in chronic medical complications: diabetes. Semin Perinatol 2011; 35 (05) 297-301
• 8 Spong CY, Mercer BM, D'Alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118 (2 Pt 1): 323-333
• 9 Khashu M, Narayanan M, Bhargava S, Osiovich H. Perinatal outcomes associated with preterm birth at 33 to 36 weeks' gestation: a population-based cohort study. Pediatrics 2009; 123 (01) 109-113
• 10 Respiratory morbidity in late preterm births. https://jamanetwork.com/
• 11 Melamed N, Klinger G, Tenenbaum-Gavish K. et al. Short-term neonatal outcome in low-risk, spontaneous, singleton, late preterm deliveries. Obstet Gynecol 2009; 114 (2 Pt 1): 253-260
• 12 Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Caughey AB. Risk of stillbirth and infant death stratified by gestational age. Obstet Gynecol 2012; Jul; 120 (01) 76-82
• 13 Mortier I, Blanc J, Tosello B, Gire C, Bretelle F, Carcopino X. 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 (06) 1071-1077
• 14 Medically indicated late-preterm and early-term deliveries | ACOG. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/07/medically-indicated-late-preterm-and-early-term-deliveries
• 15 Mackin ST, Nelson SM, Wild SH, Colhoun HM, Wood R, Lindsay RS. SDRN Epidemiology Group and Scottish Diabetes Group Pregnancy subgroup. Factors associated with stillbirth in women with diabetes. Diabetologia 2019; 62 (10) 1938-1947
• 16 Murphy HR, Steel SA, Roland JM. et al; East Anglia Study Group for Improving Pregnancy Outcomes in Women with Diabetes (EASIPOD). Obstetric and perinatal outcomes in pregnancies complicated by Type 1 and Type 2 diabetes: influences of glycaemic control, obesity and social disadvantage. Diabet Med 2011; 28 (09) 1060-1067