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

Poster Number: 401
Publication Number: 401.436

Jing Yuan, Qingdao Women and children’s Hospital, Qingdao, Shandong, China (People's Republic); Xinyue Gu, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Jie Yang, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China (People's Republic); Xinzhu Lin, Department of Neonatology, Xiamen Women and Children's Hospital, Xiamen, Fujian, China (People's Republic); Lizhong Du, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (People's Republic); Wenhao Zhou, Children's Hospital, Shanghai, Shanghai, China (People's Republic); Ruobing Shan, Qingdao Women and children’s Hospita, Qingdao, Shandong, China (People's Republic); Yun Cao, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic)

Background: Maternal diabetes mellitus (MDM) is a significant risk factor for preterm birth, with very preterm infants (VPI) at the highest risks of mortality and morbidities. The incidence of MDM is reported to be significantly higher in China than many developed countries. However, there are no large-scale studies evaluating the impact of MDM on the outcome of VPIs in China. The association between MDM and neonatal outcomes of VPIs remains controversial and has not assessed in the Chinese population.

Objective: To determine the associations between MDM and the mortality and severe morbidities of VPI, as well as the effects of insulin-treated MDM.

Design/Methods: This retrospective cohort study included all preterm infants born at 24+0～31+6 weeks’ gestation and admitted to 57 participating hospitals of the Chinese Neonatal Network in 2019. Those with major congenital anomalies and missing maternal diabetes diagnosis were excluded. Multivariate logistic regression was used to assess the association of MDM and neonatal outcomes. The association of severity of maternal diabetes mellitus and neonatal outcomes was also investigated by comparing infants born to MDM mother with or without insulin treatment.

Results: A total of 9244 VPI were included in this study. The incidence of MDM was 17.1% (n=1584). Among MDM mothers with valid treatment data, 18.0% (n=256/1420) were treated with insulin. The rates of mortality or any major morbidities (early and late onset sepsis, necrotizing enterocolitis (stage≥2), severe retinopathy of prematurity (stage≥3), severe brain injury, intraventricular hemorrhage (grade ≥3) and/or cystic periventricular leucomalacia) in MDM group and non-MDM group were 45.9% (727/1584) and 48.1% (3682/7660), respectively. After adjustment, the risk of mortality or any major morbidities among very preterm infants was not significantly increased in the MDM group [adjusted odds ratio (aOR): 1.07, 95% CI: 0.94-1.22], compared to non-MDM group. Insulin-treated MDM was not independently associated with the risk of mortality or any major morbidities (aOR: 1.01, 95% CI: 0.76-1.34) among very preterm infants, but was associated with an increased risk of severe retinopathy of prematurity (aOR: 2.39, 95% CI: 1.13-5.04).Conclusion(s): Among VPI, MDM was not associated with increased risk of mortality or major morbidities. Long-term outcomes, such as diabetes among infants, should be considered in future study. Insulin treatment was associated with an increased risk of severe retinopathy of prematurity among VPIs.
Table 1, Rate of maternal diabetes and insulin usage for very preterm infants in China
Table 2, Neonatal outcomes of very preterm infants from 24+0 to 31+6 weeks born to non-MDM and MDM mothers