Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut.
Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, Florida.
Pediatrics. 2023 Dec 1;152(6). doi: 10.1542/peds.2023-061285.
To compare differences in short term morbidities and early growth among moderate and late preterm infants of mothers with and without diabetes (DM) in pregnancy.
In a longitudinal analysis using data from the Pediatrix Clinical Data Warehouse of preterm infants (born 32 0/7 to 36 6/7 weeks) discharged from neonatal intensive care units from 2008 to 2019, health characteristics were compared between DM exposure groups. Change in growth from birth to discharge were compared using linear mixed effects modeling.
Among 301 499 moderate and late preterm infants in the analysis, 14% (N = 42 519) were exposed to DM in pregnancy. Incidence of congenital anomalies, hypoglycemia, and hyperbilirubinemia were higher in DM-group (P < .001), and DM-group was more likely to need respiratory support in the first postnatal days (P = .02). Percent weight change from birth differed by gestational age, such that 36-week DM-group infants remained on average 2% (95% confidence interval [CI]: 1.57 to 2.41) below birth weight on day 14, whereas 32-week DM-group infants were on average 2.1% (95% CI: 1.69 to 2.51) above birth weight on day 14. In the regression analysis, DM-group had faster weight loss in the first postnatal week when stratified by gestational age. The adjusted difference in weight velocity (g per day) from days 0 to 3 was -4.5 (95% CI: -5.1 to -3.9), -6.5 (95% CI: -7.4 to -5.7), and -7.2 (95% CI: -8.2 to -6.2) for infants born 34-, 35-, and 36-weeks, respectively.
In moderate or late preterm infants, diabetes in pregnancy is associated with common neonatal morbidities. Examination of intensive care nutritional practices may identify reasons for observed differences in weight trajectories by gestational age and diabetes exposure.
比较患有和不患有妊娠糖尿病（DM）的孕妇所生的中晚期早产儿在短期发病和早期生长方面的差异。
使用来自 2008 年至 2019 年新生儿重症监护病房出院的早产儿（胎龄 32 0/7 至 36 6/7 周）的 Pediatrix 临床数据仓库中的纵向分析数据，比较 DM 暴露组之间的健康特征。使用线性混合效应模型比较从出生到出院的生长变化。
在分析的 301499 名中晚期早产儿中，14%（N=42519）在妊娠期间暴露于 DM。DM 组的先天畸形、低血糖和高胆红素血症的发生率更高（P<.001），且 DM 组在出生后第 1 天更需要呼吸支持（P=.02）。出生体重的体重变化百分比因胎龄而异，例如，36 周 DM 组婴儿在第 14 天平均比出生体重低 2%（95%置信区间 [CI]：1.57 至 2.41），而 32 周 DM 组婴儿在第 14 天平均比出生体重高 2.1%（95%CI：1.69 至 2.51）。在按胎龄分层的回归分析中，DM 组在出生后的第 1 周体重下降更快。体重速度（每天克）的调整差异为 0 至 3 天为-4.5（95%CI：-5.1 至 -3.9），-6.5（95%CI：-7.4 至 -5.7）和-7.2（95%CI：-8.2 至 -6.2），分别适用于出生时胎龄为 34 周、35 周和 36 周的婴儿。
在中晚期早产儿中，妊娠糖尿病与常见的新生儿发病有关。检查重症监护营养实践可能会发现胎龄和糖尿病暴露观察到的体重轨迹差异的原因。
